生脉注射液联合前列地尔对脓毒症急性肝损伤患者炎症反应及氧化应激水平的影响

Effects of Shengmai injection combined with alprostadil on inflammation and oxidative stress in patients with acute liver injury due to sepsis

目的探讨生脉注射液联合前列地尔对脓毒症急性肝损伤患者氧化应激及全身炎症反应的影响。方法选取2017年6月至2019年6月河南科技大学第一附属医院急诊科收治的脓毒症合并肝损害患者100例作为研究对象,采用随机数表法将其分为研究组(n=50)及对照组(n=50),对照组患者采用前列地尔进行治疗,研究组患者在此基础上联用生脉注射液进行治疗。对两组患者治疗前后临床结局、肝功能指标、全身炎性因子及氧化应激水平进行比较。结果治疗7 d后,研究组患者急性生理和慢性健康评分(APACHEⅡ)及序贯器官衰竭评分(SOFA)[(12.8±2.5)、(4.8±1.6)]显著低于对照组患者[(16.1±3.7)、(6.9±1.9)],差异有统计学意义(P<0.05)。研究组患者ICU住院时间及死亡率[(11.3±3.1)d、4.00%]低于对照组患者[(14.7±3.6)d、16.00%],差异有统计学意义(P<0.05)。研究组患者天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及总胆红素(TB)水平[(126.5±29.4)U/L、(43.9±7.1)U/L、(28.3±2.6)μmol/L]显著低于对照组患者[(143.2±34.4)U/L、(56.8±7.6)U/L、(33.5±2.7)μmol/L],差异有统计学意义(P<0.05)。研究组患者C-反应蛋白(CRP)、降钙素原(PCT)及白细胞介素-6(IL-6)水平[(8.4±2.9)mg/L、(1.4±0.3)ng/mL、(38.4±11.4)pg/mL]显著低于对照组患者[(11.3±3.8)mg/L、(1.8±0.3)ng/mL、(49.4±13.5)pg/mL],差异有统计学意义(P<0.05)。研究组患者丙二醛(MDA)、蛋白氧化产物(AOPP)水平[(6.8±1.9)μmol/L、(21.6±5.7)μmol/L]显著低于对照组患者[(7.9±2.1)μmol/L、(25.9±6.6)μmol/L],差异有统计学意义(P<0.05),超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平[(93.9±12.3)U/L、(51.3±11.2)g/L]高于对照组患者[(79.6±10.1)U/L、(47.3±9.2)g/L],差异有统计学意义(P<0.05)。结论生脉注射液联合前列地尔可有效改善脓毒症合并急性肝损伤患者临床结局,纠正其肝功能指标、全身炎性因子及氧化应激水平,值得进行临床推广。

Objective To investigate the effects of Shengmai injection combined with alprostadil on oxidative stress and systemic inflammatory response in patients with acute liver injury in sepsis.Methods 100 patients with sepsis and liver damage treated in the emergency department of the First Affiliated Hospital of Henan University of Science and Technology between June 2017 and June 2019 were selected as the research objects,and they were divided into study groups(n=50)by random number table and control group(n=50);patients in the control group were treated with alprostadil,and patients in the study group were treated with Shengmai injection on this basis.The clinical outcomes,liver function indexes,systemic inflammatory factors,and oxidative stress levels were compared between the two groups of patients before and after treatment.Results After 7 days of treatment,the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and sequential organ failure evaluation(SOFA)score of the study group[(12.8±2.5)and(4.8±1.6)]were significantly lower than those of the control group[(16.1±3.7)and(6.9±1.9)](P<0.05).ICU hospital stay(11.3±3.1)d and mortality(4.00%)in the study group were lower than those in the control group[(14.7±3.6)d and 16.00%];the difference were statistically significant(P<0.05).After 7 days of treatment,aspartate transaminase(AST),alanine aminotransferase(ALT)and total bilirubin(TB)levels[(126.5±29.4)U/L,(43.9±7.1)U/L and(28.3±2.6)μmol/L,respectively]of the study group were significantly lower than those in the control group[(143.2±34.4)U/L,(56.8±7.6)U/L and(33.5±2.7)μmol/L,respectively](P<0.05).C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)levels[(8.4±2.9)mg/L,(1.4±0.3)ng/mL and(38.4±11.4)pg/mL,respectively]of the study group were significantly lower than those in the control group[(11.3±3.8)mg/L,(1.8±0.3)ng/mL and(49.4±13.5)pg/mL,respectively](P<0.05).After 7 days of treatment,the malondialdehyde(MDA)and advanced oxidation protein products(AOPP)levels[(6.8±1.9)μmol/L,and(21.6±5.7)μmol/L,respectively]in study group were significantly lower than those in the control group[(7.9±2.1)μmol/L and(25.9±6.6)μmol/L,respectively](P<0.05).Superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)levels[(93.9±12.3)U/L and(51.3±11.2)g/L,respectively]of the study group were significantly higher than those in the control group[(79.6±10.1)U/L and(47.3±9.2)g/L,respectively](P<0.05).Conclusion Shengmai injection combined with alprostadil could effectively improve the clinical outcome of patients with sepsis and acute liver injury,and correct their liver function indexes,systemic inflammatory factors and oxidative stress levels,which should be worth of clinical promotion.