清胰汤合大承气汤加减治疗对重症急性胰腺炎患者炎性应激、肠黏膜功能及免疫功能的影响

Effect of Qingyi Decoction Combined with Dachengqi Decoction on Inflammatory Stress,Intestinal Mucosal Function and Immune Function for Patients with Severe Acute Pancreatitis

目的:观察清胰汤合大承气汤加减治疗对重症急性胰腺炎患者炎性应激、肠黏膜功能及免疫功能的影响。方法:选取2018年1月~2020年6月本院收治的重症急性胰腺炎(Severe Acute Pancreatitis,SAP)患者82例作为研究对象,根据不同诊治方式分为研究组(n=41)和对照组(n=41),对照组患者予以西医对症支持治疗,研究组在对照组基础上联合清胰汤合大承气汤加减治疗。比较两组患者临床疗效、炎性应激[肿瘤坏死因子(Tumor Necrosis Factor,TNF-α)、白介素-6(Interleukin 6,IL-6)、C-反应蛋白(C-reactive Protein,CRP)]、肠粘膜功能[内毒素、二胺氧化酶(Diamine Oxidase,DAO)、乳酸]、免疫功能[T淋巴细胞亚群(CD_(8)^(+)、CD_(4)^(+)、CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+))]、不良反应(恶心、呕吐、肝肾功能异常)及病死率。结果:(1)研究组总有效率显著高于对照组(95.12%vs 73.17%)(P<0.05);(2)治疗后,两组患者TNF-a、IL-6、hn-CRP水平较治疗前下降,以研究组为甚(P<0.05);(3)治疗后,研究组与对照组患者内毒素、乳酸、DAP等指标较治疗前降低,且研究组显著低于对照组(P<0.05);(4)两组患者CD_(4)^(+)、CD_(3)^(+)、CD_(8)^(+)、治疗后较治疗前均有所上升,CD_4^(+)/CD_8^(+)较治疗前下降,以研究组为甚(P<0.05);(5)研究组出现恶心、呕吐、肝肾功能异常等不良反应总发生率明显低于对照组,且研究组病死率较对照组低(P<0.05)。结论:清胰汤合大承气汤加减治疗重症急性胰腺炎患者临床疗效显著,可在改善患者炎性应激的同时,提升免疫功能,保护患者胃肠黏膜屏障,病死率低,值得临床推广。

Objective:To analyze the effect of Qingyi Decoction combined with Dachengqi Decoction on inflammatory stress,intestinal mucosal function and immune function for patients with severe acute pancreatitis.Methods:82 patients with severe acute pancreatitis(SAP)who were admitted to our hospital from January 2018 to June 2020 were selected as the study subjects.According to different diagnosis and treatment methods,they were divided into a study group(n=41)and a controlled group(n=41).Patients in the controlled group were treated with symptomatic and supportive treatment of western medicine,and patients in the study group was supplemented with Qingyi Decoction combined with Dachengqi Decoction.The clinical efficacy,inflammatory stress[tumor necrosis factor(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)],intestinal mucosal function[endotoxin,diamine oxidase(DAO),lactic acid],immune function[T lymphocyte subsets(CD_(8)^(+),CD_(4)^(+),CD_(3)^(+),CD_(4)^(+)/CD_(8)^(+))],adverse reactions(nausea,vomiting,abnormal liver and kidney function)and mortality of patients between the two groups were compared.Results:(1)The total effective rate of the study group was significantly higher than that of the controlled group(95.12%vs 73.17%)(P<0.05).(2)After treatment,the levels of TNF-a,IL-6,and hn-CRP in the two groups decreased compared with those before treatment,especially in the study group(P<0.05).(3)After treatment,the endotoxin,lactic acid,DAP and other indicators of the study group and the controlled group were lower than those before treatment,and the level of the study group was significantly lower than that of the controlled group(P<0.05).(4)CD_(4)^(+),CD_(3)^(+),CD_(8)^(+),CD_(4)^(+),CD_(3)^(+),CD_(8)^(+),and CD_(4)^(+)/CD_(8)^(+)decreased after treatment compared with those before treatment,especially in the study group(P<0.05).(5)The total incidence of adverse reactions such as nausea,vomiting,abnormal liver and kidney function in the study group was significantly lower than that in the controlled group,and the mortality rate in the study group was lower than that in the controlled group(P<0.05).Conclusion:Qingyi Decoction combined with Dachengqi Decoction have a significant clinical effect in the treatment of patients with severe acute pancreatitis.It can improve the inflammatory stress of the patients,enhance the immune function and protect the gastrointestinal mucosal barrier of the patients.The mortality rate is low and it is worthy of clinical promotion.