百草枯解毒成方辅助治疗对急性百草枯中毒患者血Ⅰ型胶原蛋白和Ⅲ型前胶原肽及转化生长因子β1的影响

Effect of paraquat detoxification prescription on blood typeⅠcollagen protein,typeⅢprocollagen peptide and transforming growth factor-β1 in patients with acute paraquat poisoning

目的观察百草枯解毒成方辅助治疗对急性百草枯中毒(APP)患者Ⅰ型胶原蛋白(PⅠCP)、Ⅲ型前胶原肽(PⅢNP)及转化生长因子β1(TGF-β1)的影响。方法选择河北医科大学附属衡水市人民医院2016年7月至2018年7月收治的APP患者78例,按入院先后顺序随机分为对照组和观察组,各39例。2组患者均给予常规系列治疗,对照组在洗胃后给予20%甘露醇导泻;观察组在洗胃后给予百草枯解毒1号方导泻,导泻结束后加用百草枯解毒2号方口服,2次/d,连用14 d。2组患者均在治疗前及治疗3、7、14、28 d后检测动脉血氧分压(PaO2)、PⅠCP、PⅢNP、TGF-β1并行胸部高分辨率CT(HRCT)检查。统计2组患者28 d病死率。结果观察组28 d病死率明显低于对照组[48.7%(19/39)比71.8%(28/39)](P<0.05)。2组治疗后HRCT评分逐渐增加,治疗14 d后达到顶峰然后逐渐下降,观察组治疗3、7、14、28 d后HRCT评分均明显低于对照组(均P<0.05)。2组治疗后PaO2逐渐降低,治疗7 d后降至最低然后逐渐回升,观察组回升迅速;PⅠCP、PⅢNP及TGF-β1逐渐升高,治疗7 d后达高峰然后逐渐下降,观察组下降更快;观察组治疗3、7、14、28 d后的PaO2均高于对照组,而PⅠCP、PⅢNP及TGF-β1均低于对照组,差异均有统计学意义(均P<0.05)。结论百草枯解毒成方辅助治疗能使APP患者血中PICP、PⅢNP及TGF-β1增长缓慢,延缓肺纤维化形成,改善预后,降低患者病死率。

Objective To observe the effect of paraquat detoxification prescription on blood typeⅠcollagen protein(PⅠCP),typeⅢprocollagen peptide(PⅢNP)and transforming growth factor-β1(TGF-β1)in patients with acute paraquat poisoning(APP).Methods Totally 78 patients with APP admitted to Hengshui People’s Hospital Affiliated to Hebei Medical University from July 2016 to July 2018 were randomly divided into control group and observation group,with 39 cases in each group.On the basis of routine treatment,the control group was given 20%mannitol catharsis following gastric lavage;the observation group was given paraquat detoxification prescription No.1 following gastric lavage and took paraquat detoxification prescription No.2 twice a day for 14 days.Arterial partial pressure of oxygen(PaO2),blood contents of PⅠCP,PⅢNP,TGF-β1 and chest high resolution CT(HRCT)were examined before and 3,7,14,28 days after treatment.The 28 d mortality was observed.Results The 28 d mortality rate in observation group was significantly lower than that in control group[48.7%(19/39)vs 71.8%(28/39)](P<0.05).HRCT score reached the peak after 14 days of treatment in both groups and then decreased;the 3,7,14,28 d HRCT scores in observation group were significantly lower than those in control group(all P<0.05).PaO2 dropped in 7 days and then recovered,with a more significant rising rate in observation group;PⅠCP,PⅢNP and TGF-β1 levels increased in 7 days and then decreased,with a more significant decreasing rate in observation group.At 3,7,14,28 days after treatment,Pa O2 in observation group was significantly higher and PⅠCP,PⅢNP,TGF-β1 levels were lower than those in control group(all P<0.05).Conclusion Paraquat detoxification prescription treating APP can reduce the production of PICP,PⅢNP and TGF-β1 in blood,delay the formation of pulmonary fibrosis,improve the prognosis and reduce the mortality rate.