小青龙汤干预慢性阻塞性肺疾病急性加重期低钠血症研究

Effect of Xiaoqinglong Decoction in the intervention of acute exacerbation of chronic obstructive pulmonary disease with hyponatremia

目的探讨慢性阻塞性肺疾病急性加重期(acute exacerbation chronic obstruetive pulmonary diseas,AECOPD)低钠血症与内分泌激素、缺氧程度的相关性,揭示小青龙汤干预AECOPD低钠血症的机制。方法按纳入标准选取121例AECOPD患者作为慢阻肺组,选取50例健康体检者作为健康组。同时测定健康组和慢阻肺组血钠和血清总三碘甲状腺原氨酸(total triiodothyrogenine,TT3)、总四碘甲状腺原氨酸(total tetraiodothyrogenine,TT4)、促甲状腺激素(thyroid stimulating hormone,TSH)、血清皮质醇(free cortisol,FC)、醛固酮(aldosterone,ALD)、促肾上腺皮质激素(adrenocorticotropin,ACTH)等激素水平。选取慢阻肺组合并存在低钠血症者53例作为观察组,按低钠血症水平(轻、中、重三度)1∶1方式随机分成治疗组27例和对照组26例。对照组给予常规西医抗感染等综合治疗,治疗组在对照组基础上给予小青龙汤每日一剂口服,疗程2周。观察组治疗前后测定动脉氧分压(PaO2),疗程结束后复查血钠、TT3、TT4、TSH、FC、ALD、ACTH等激素水平。综合探讨AECOPD患者低钠血症、内分泌激素、缺氧程度三者之间的相关性,以揭示小青龙汤改善AECOPD低钠血症的可能机制。结果慢阻肺组低钠血症发生率较高,约43.8%,血钠[(131±5)mmol/L]明显低于健康组[(140±6)mmol/L,t=9.701,P<0.001];慢阻肺组TT3[(0.98±0.17)nmol/L比(2.33±0.32)nmol/L,t=28.534]、TT4[(55±27)nmol/L比(114±32)nmol/L,t=11.697]、TSH[(1.65±0.97)mu/L比(3.25±1.14)mu/L,t=7.644]、FC[(127±25)nmol/L比(239±32)nmol/L,t=14.191]均低于健康组(P<0.001),ALD[(673±115)pmol/L比(238±104)pmol/L,t=-20.011]、ACTH[(18.3±4.6)pmol/L比(10.5±2.9)pmol/L,t=-10.198]明显高于健康组(P<0.001);慢阻肺组存在程度不等的低氧血症,尤其是观察组,血钠水平越低,缺氧程度越重(t值分别为-10.057、-10.194,P<0.001),TT3(t值分别为-1.676、-1.719,P<0.001)、TT4(t值分别为-11.476、-11.516,P<0.001)、TSH(t值分别为-1.575、-1.597,P<0.001)、FC(t值分别为-1.695、-1.857,P<0.001)、ALD(t值分别为15.684、16.198,P<0.001)、ACTH(t值分别为0.712、0.748,P<0.001)等激素水平异常程度越重;治疗后治疗组PaO2[(65±9)mmHg比(60±8)mmHg,t=-5.873]、TT3[(2.15±0.30)nmol/L比(1.45±0.21)nmol/L,t=-6.706]、TT4[(110±18)nmol/L比(92±20)nmol/L,t=-3.8165]、TSH[(3.14±1.22)mul/L比(2.99±1.97)mu/L,t=-1.596]、FC[(231±31)nmol/L比(207±28)nmol/L,t=-15.791]、ALD[(253±119)pmol/L比(275±121)pmol/L,t=0.973]、ACTH[(11.4±3.1)pmol/L比(13.6±3.6)pmol/L,t=0.719]、血钠[(141±8)mmol/L比(136±7)mmol/L,t=-9.359]等指标恢复水平明显优于对照组(P<0.001)。结论AECOPD易发生低钠血症和内分泌激素水平紊乱;AECOPD患者低钠程度、内分泌激素水平异常程度与缺氧程度密切相关,缺氧程度越重,内分泌激素水平异常程度越重,血钠水平越低;小青龙汤能够改善AECOPD患者的缺氧,纠正内分泌激素水平异常程度,最终改善低钠血症的程度。

Objective:To explore the correlation between hyponatremia and endocrine hormone and hypoxia in acute exacerbation of chronic obstructive pulmonary disease,and to reveal the mechanism of Xiaoqinglong Decoction in the intervention of AECOPD hyponatremia.Methods:According to the inclusion criteria,121 patients with AECOPD were selected as the chronic obstructive pulmonary disease group,and 50 healthy subjects were selected as the healthy group.At the same time,the levels of serum sodium and serum total triiodothyronine,total tetraiodothyronine,thyroid stimulating hormone,serum cortisol,aldosterone and adrenocorticotropic hormone were measured in the healthy group and chronic obstructive pulmonary disease group.A total of 53 AECOPD patients with hyponatremia were selected as the observation group.They were randomly divided into treatment group(27 cases)and control group(26 cases)according to the level of hyponatremia(light,medium and heavy three degrees).The control group was given conventional western medicine for anti-infective and other comprehensive treatments.The treatment group was given a daily oral administration of Xiaoqinglong Decoction on the basis of the control group for 2 weeks.The patients in the observation group were measured for arterial oxygen partial pressure(PaO2)before and after treatment.At the end of the treatment period,the levels of serum sodium,TT3,TT4,TSH,FC,ALD,and ACTH were measured in the observation group.to explore the correlation between hyponatremia,endocrine hormone and hypoxia in patients with AECOPD,and to reveal the possible mechanism of Xiaoqinglong Decoction in improving AECOPD hyponatremia.Results:①The incidence of hyponatremia in patients with chronic obstructive pulmonary disease was higher,about 43.8%,blood sodium level[(131±5)mmol/L vs.(140±6)mmol/L,t=9.701]was significantly lower than that in healthy group(P<0.001);②Hormone levels such as TT3[(0.98±0.17)nmol/L vs.(2.33±0.32)nmol/L,t=28.534],TT4[(55±27)nmol/L vs.(114±32)nmol/L,t=11.697],TSH[(1.65±0.97)mu/L vs.(3.25±1.14)mu/L,t=7.644],FC[(127±25)nmol/L vs.(239±32)nmol/L,t=14.191]in chronic obstructive pulmonary disease group below the healthy group(P<0.001),ALD,ACTH and other hormone levels were significantly higher than those in the healthy group(P<0.001);③Patients with chronic obstructive pulmonary disease had varying degrees of hypoxemia,especially in the observation group(t=-10.057、-10.194,P<0.001).The lower the blood sodium level was,the more disordered the levels of TT3(t=-1.676、-1.719,P<0.001),TT4(t=-11.476、-11.516,P<0.001),TSH(t=-1.575、-1.597,P<0.001),FC(t=-1.695、-1.857,P<0.001),ALD(t=15.684、16.198,P<0.001),and ACTH(t=0.712、0.748,P<0.001)hormones,and the more severe the hypoxia was;④After treatment,the treatment group patients with PaO2[(65±9)mmol/L vs.(60±8)mmol/L,t=-5.873],the recovery levels of TT3[(2.15±0.30)nmol/L vs.(1.45±0.21)nmol/L,t=-6.706],TT4(110±18)nmol/L vs.(92±20)nmol/L,t=-3.8165],TSH[(3.14±1.22)mul/L vs.(2.99±1.97)mu/L,t=-1.596],FC[(231±31)nmol/L vs.(207±28)nmol/L,t=-15.791],ALD[(253±119)pmol/L vs.(275±121)pmol/L,t=0.973]and ACTH[(11.4±3.1)pmol/L vs.(13.6±3.6)pmol/L,t=0.719],hyponatremia[(141±8)mmol/L vs.(136±7)mmol/L,t=-9.357]were significantly better than those of the control group(P<0.001).Conclusion:①AECOPD patients are prone to hyponatremia and endocrine hormone levels disorder;②AECOPD patients with hyponatremia levels,endocrine hormone levels and degree of hypoxia are closely related,the more severe the degree of hypoxia is,the greater the degree of disorder of endocrine hormones is,and the more severe hyponatremia is;③Xiaoqinglong decoction can improve the degree of hypoxia in patients with AECOPD patients.After hypoxia is improved,the level of endocrine hormones in AECOPD patients is corrected and hyponatremia is improved.