四逆汤对脓毒症(心肾阳衰证)患者C5a和C3a的影响

Effect of Sini Decoction on C5a and C3a in Sepsis Patients with Yang Deficiency of Heart and Kidney

目的观察四逆汤对脓毒症(心肾阳衰证)患者C5a和C3a的影响。方法患者60例随机分为对照组与四逆汤组,每组30例。对照组参照指南给予常规治疗,四逆汤组在对照组的基础上加用四逆汤治疗,每日1剂,早晚温服或鼻饲,连续7 d或直至心肾阳衰证消失。分别于纳入研究的第1天、第3天及第7天以ELISA检测血清中C3a和C5a水平,比较急性生理与慢性健康评分量表Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分表(SOFA)评分和28 d死亡率在组间的差异性。结果四逆汤组患者经治疗后,第3天及第7天检测的C5a水平均较第1天下降明显(P<0.05),且相较同期对照组水平更低(P<0.05)。而两组28 d死亡率以及C3a、APACHEⅡ评分和SOFA评分在治疗后第3天及第7天的比较均未发现明显差异(P>0.05)。结论四逆汤能降低心肾阳衰脓毒症患者血清中C5a水平,这可能是其治疗脓毒症的部分机制。

Objective:To observe the effect of Sini Decoction on C5a and C3a in sepsis patients with Yang defi⁃ciency of heart and kidney.Methods:A total of 60 sepsis patients with Yang deficiency of heart and kidney from August 2019 to April 2020 were enrolled in the intensive care unit of The Second People′s Hospital Affiliated to Fujian University of Traditional Chinese Medicine.They were randomly divided into the control group and Sini De⁃coction group,30 cases in each group.The control group was given routine treatment according to the guidelines.In Sini Decoction group,on the basis of the control group,one dose of Sini Decoction was taken orally or given by nasogastric tube for 7 days or until the Yang deficiency of heart and kidney disappeared,if the duration of Yang deficiency of heart and kidney was less than 7 days.The serum C3a and C5a were detected by ELISA on the day 1,3,7 of the study,and the differences of APACHEⅡscore,SOFA score and 28-day mortality rate among the groups were compared.Results:After treatment,the levels of C5a in the Sini Decoction group on day 3 and 7 were significantly lower than that of the day 1,and were lower than those in the control group(P<0.05).However,there was no difference in the 28-day mortality rate between the two groups.In addition,C3a,APACHEⅡscore and SOFA score on day 3 and 7 after treatment were the same between the two groups(P>0.05).Conclusion:Si⁃ni Decoction can reduce the serum C5a level of sepsis patients with Yang deficiency of heart and kidney,which may be part of the therapeutic mechanism of Sini decoction for sepsis.