炎调方对脓毒症(热毒炽盛证)患者炎症反应及细胞免疫功能的影响

Effects of Yantiao Decoction on inflammatory reaction and cellular immune function in patients of sepsis with syndrome of heat-toxin exuberance

目的:观察炎调方对脓毒症热毒炽盛证患者炎症反应和细胞免疫功能的影响,探讨炎调方在脓毒症治疗中的免疫调理作用。方法:纳入60例脓毒症热毒炽盛证患者,随机分为治疗组和对照组,每组各30例。对照组患者给予西医常规治疗,治疗组患者给予西医常规治疗结合中药炎调方口服,两组疗程均为7 d。评价两组患者的中医证候疗效,比较两组患者的中医症状积分及急性生理与慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA),检测所有患者的炎症指标[包括白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)、白介素-8(IL-8)]及细胞免疫指标[包括CD4^+、CD8^+、CD3^+/HLA-DR^+T淋巴细胞比例及CD4^+/CD8^+比值]水平。结果:(1)治疗后,治疗组的中医证候疗效总有效率为90.0%,对照组为80.0%,治疗组的疗效优于对照组(P<0.05)。(2)治疗后,两组患者的中医症状积分及APACHEⅡ、SOFA评分较治疗前均显著降低(P<0.05),且治疗组患者的中医症状积分及SOFA评分低于对照组(P<0.05)。(3)治疗后,两组患者的WBC、CRP、PCT、IL-6、IL-8水平较治疗前均显著降低(P<0.05),且治疗组患者的WBC、CRP、PCT、IL-6水平低于对照组(P<0.05)。(4)治疗后,两组患者的CD4^+、CD3^+/HLA-DR^+T淋巴细胞比例及CD4^+/CD8^+比值较治疗前均明显升高(P<0.05),且治疗组患者的CD4^+、CD3^+/HLA-DR^+T淋巴细胞比例及CD4^+/CD8^+比值均明显高于对照组(P<0.05)。结论:炎调方治疗脓毒症具有较好的临床疗效,可减轻患者的临床症状,改善患者的炎症和免疫指标。

Objective:To observe the effects of Yantiao Decoction on the inflammatory reaction and cellular immune function in patients of sepsis with syndrome of heat-toxin exuberance,and explore the immunomodulatory role of Yantiao Decoction in the treatment of sepsis.Methods:Sixty patients of sepsis with syndrome of heat-toxin exuberance were included and randomly divided into the treatment group and the control group,30 cases in each group.The patients in the control group were treated with conventional western medicine,and the patients in the treatment group were treated with conventional western medicine and Yantiao Decoction by oral administration,with a course of 7 days.The efficacy on Chinese medical syndrome was evaluated in both groups,the scores of Chinese medical symptoms,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)were compared between the two groups,and the levels of inflammatory and cellular immune indexes were detected,including white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT),interleukin(IL)-6,IL-8,proportions of CD4^+,CD8^+and CD3^+/HLA-DR+T lymphocytes,and CD4^+/CD8^+ratio.Results:(1)After treatment,the total effective rates of Chinese medical syndrome were 90.0%in the treatment group and 80.0%in the control group,and the efficacy of the treatment group was better than that of the control group(P<0.05).(2)After treatment,the scores of Chinese medical symptoms,APACHEⅡand SOFA were significantly decreased in both groups compared with those before treatment(P<0.05),and the scores of Chinese medical symptoms and SOFA in the treatment group were lower than those in the control group(P<0.05).(3)After treatment,the levels of WBC,CRP,PCT,IL-6 and IL-8 were obviously decreased in both groups compared with those before treatment(P<0.05),and the levels of WBC,CRP,PCT and IL-6 in the treatment group were lower than those in the control group(P<0.05).(4)After treatment,the proportions of CD4^+and CD3^+/HLA-DR+T lymphocytes and the CD4^+/CD8^+ratio were significantly increased in both groups compared with those before treatment(P<0.05),and the proportions of CD4^+and CD3^+/HLA-DR+T lymphocytes and the CD4^+/CD8^+ratio in the treatment group were obviously higher than those in the control group(P<0.05).Conclusion:Yantiao Decoction shows better clinical efficacy in the treatment of sepsis,which can relieve the clinical symptoms of patients,and improve the inflammatory and immune indexes.