桃仁承气汤治疗40例脓毒症患儿的临床疗效及对肠黏膜屏障、TLRs通路的调节作用

Efficacy of Taoren Chengqi Decoction on Children With Sepsis and Its Regulation on Intestinal Mucosal Barrier and Tlrs Pathway

目的研究桃仁承气汤治疗脓毒症患儿的临床疗效及对肠黏膜屏障、Toll样受体(toll like receptors,TLRs)通路的调节作用。方法选取2018年1月—2020年12月期间于广东省第二人民医院儿科就诊的80例脓毒症患儿,采用随机数表法随机分为对照组和观察组,每组40例。对照组予常规治疗,观察组在对照组基础加用桃仁承气汤,两组患儿均连续治疗7 d。治疗7 d后,观察比较两组患儿临床疗效,评价治疗前后急性生理和慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯性器官衰竭评分(sequential organ failure assessment,SOFA),检测血清内毒素、D-乳酸、二胺氧化酶、肿瘤坏死因子-α(tumor necrosis factor-alhpa,TNF-α)、白介素-6(interleukin-6,IL-6)、高迁移率族蛋白B1(high mobility group box 1,HMGB1)含量及外周血Toll样受体2(toll-like receptor 2,TLR-2)、Toll样受体4(toll-like receptor 4,TLR-4)、Toll样受体9(toll-like receptor 9,TLR-9)表达水平。结果治疗7 d后,观察组患儿治疗总有效率90.00%(36/40)明显高于对照组患儿治疗总有效率70.00%(28/40),两组比较,差异有统计学意义(P<0.05)。治疗7 d后两组患儿APACHEⅡ、SOFA评分与治疗前比较均降低,差异有统计学意义(P<0.05),观察组患儿APACHEⅡ、SOFA评分均低于对照组,差异有统计学意义(P<0.05)。治疗7 d后两组患儿的血清内毒素、D-乳酸、二胺氧化酶含量与治疗前比较均降低,差异有统计学意义(P<0.05),观察组患儿的血清内毒素、D-乳酸、二胺氧化酶含量均低于对照组,差异有统计学意义(P<0.05)。治疗7 d后两组患儿的外周血TLR2、TLR4、TLR9表达水平与治疗前比较均降低,差异有统计学意义(P<0.05),观察组患儿的外周血TLR2、TLR4、TLR9表达水平均低于对照组,差异有统计学意义(P<0.05)。治疗7 d后两组患儿的血清TNF-α、IL-6、HMGB1含量与治疗前比较均降低,差异有统计学意义(P<0.05),观察组患儿的血清TNF-α、IL-6、HMGB1含量均低于对照组,差异有统计学意义(P<0.05)。观察组患者28 d累积死亡3例、对照组患儿28 d累积死亡10例,观察组患儿的28 d累积病死率低于对照组,差异有统计学意义(P<0.05)。结论桃仁承气汤治疗脓毒症患儿能够改进疗效并改善肠黏膜屏障功能、抑制TLRs通路介导的炎症反应激活。

Objective To study the efficacy of Taoren Chengqi Decoction on children with sepsis and its regulation on intestinal mucosal barrier and toll like receptors(TLRs)pathway.Methods 80 children with sepsis treated in our hospital from January 2018 to December 2020 were selected and randomly divided into control group receiving conventional treatment and observation group receiving Taoren Chengqi Decoction combined with conventional treatment,40 cases in each group.Both groups of children were treated continuously for 7 days.After 7 days of treatment,observe and compare the clinical efficacy of the two groups of children,acute physiology and chronic health score II(APACHE II)and sequential organ failure score(SOFA)were evaluated,the contents of serum endotoxin,D-lactate,diamine oxidase,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),high mobility group box 1(HMGB1)and the expression levels of TLR2,TLR4 and TLR9 in peripheral blood were detected.Results After 7 days of treatment,the total effective rate of 90.00%(36/40)of children in the observation group was significantly higher than that of 70.00%(28/40)of children in the control group.The difference between the two groups was statistically significant(P<0.05).After 7 days of treatment,the APACHE II and SOFA scores of the two groups of children decreased compared with those before treatment,and the difference was statistically significant(P<0.05).The APACHE II and SOFA scores of the observation group were lower than those of the control group.Comparison between the two groups,the difference was statistically significant(P<0.05).After 7 days of treatment,the levels of serum endotoxin,D-lactate,and diamine oxidase of the two groups of children decreased compared with those before treatment,the difference was statistically significant(P<0.05),and the levels of serum endotoxin,D-lactate,and diamine oxidase levels of the observation group were significantly lower than those of the control group,and the difference between the two groups was statistically significant(P<0.05).After 7 days of treatment,the expression levels of TLR2,TLR4,and TLR9 in the peripheral blood of the two groups of children were lower than those before treatment,and the difference was statistically significant(P<0.05),and the expression of TLR2,TLR4,and TLR9 in the peripheral blood of the observation group The level was lower than that of the control group,and the difference between the two groups was statistically significant(P<0.05).After 7 days of treatment,the serum TNF-α,IL-6,and HMGB1 levels of the two groups of children decreased compared with those before treatment,and the difference was statistically significant(P<0.05),and the levels of serum TNF-α,IL-6 and HMGB1 of the observation group was lower than that of the control group,and the difference between the two groups was statistically significant(P<0.05).There were 3 cumulative deaths in the observation group at 28 days and 10 deaths in the control group at 28 days.The Log rank test showed that the 28-day cumulative mortality rate of the observation group was lower than that of the control group.The difference between the two groups was statistically significant.Significance(P<0.05).Conclusion Taoren Chengqi Decoction can improve the curative effect and improve the intestinal mucosal barrier function in children with sepsis,and inhibit the activation of inflammatory response mediated by TLRs pathway.