季德胜蛇药片对蛇咬伤患者创口局部和全身炎症反应的影响及机制

Effects and Mechanism of Jidesheng Anti-venom Tablet on Local Wound Inflammation and Systemic Inflammatory Response of Snake Bite Patients

目的:考察季德胜蛇药片对蛇咬伤患者创口局部和全身炎症反应的影响及其机制。方法:将2018年6月-2020年6月我院收治的蛇咬伤患者64例按照随机数字表法分为对照组和观察组各32例。两组患者均行常规清创、引流、冲洗、封闭以及抗毒、抗感染、抗纤溶和抗休克治疗,观察组患者在此基础上辅以季德胜蛇药片内服加外用,连续7d。比较两组患者的全身炎症反应相关指标、创口局部症状、住院时间、重要脏器的实验室指标、凝血功能指标、创口炎性细胞计数和血清中炎性细胞因子、趋化因子水平,以及不良反应发生情况。结果:治疗后,两组患者的全身炎症反应相关指标(呼吸频率、心率、白细胞计数)、创口局部症状(局部疼痛消失时间、创口消肿时间)、住院时间、重要脏器的实验室指标(天冬氨酸转氨酶、丙氨酸转氨酶、血肌酐、血尿素氮、肌酸激酶、肌酸激酶同工酶)、凝血功能指标(组织型纤溶酶原激活物、纤溶酶原激活抑制物1、凝血酶-抗凝血酶复合物、可溶性纤维蛋白单体复合物)、创口炎性细胞(巨噬细胞、中性粒细胞、淋巴细胞)计数和血清中炎性细胞因子[肿瘤坏死因子α、白细胞介素1、白细胞介素6、超敏C反应蛋白(hs-CRP)、核转录因子κB(NF-κB)]、趋化因子[单核细胞趋化蛋白1(MCP-1)、趋化因子配体8(CXCL-8)]水平大多显著优于治疗前(P<0.05),且观察组大多数指标显著优于对照组(P<0.05)。两组患者均未见严重不良反应发生。结论:季德胜蛇药片辅助治疗蛇咬伤可显著减轻患者创口局部和全身炎症反应症状,其机制可能与降低血清趋化因子MCP-1、CXCL-8和炎性细胞因子hs-CRP、NF-κB的水平相关。

OBJECTIVE:To investigate the effects and mechanism of Jidesh eng anti-venom tablet on local wound inflammation and systemic inflammatory response of snake bite patients.METHODS:Totally 64 patients with snake bite admitted to our hospital during Jun.2018-Jun.2020 were randomly divided into control group and observation group,with 32 cases in each group.Both groups received routine treatment,such as debridement,drainage,flushing,sealing,anti-venom,anti-infection,anti-fibrinolysis and anti-shock.Observation group was additionally given Jidesheng anti-venom tablet for internal and external use,for consecutive 7 d.Related indexes of systemic inflammatory response,local wound condition,hospital stay,laboratory indexes of important organs,coagulation function index,wound inflammatory cell counts,serum levels of inflammatory cytokines and chemokine,the occurrence of ADR were compared between 2 groups.RESULTS:After treatment,most of related indexes of systemic inflammatory response(RR,HR and WBC),local wound condition(local pain disappearance time,wound detumescence time),hospital stay,laboratory indexes of important organs(AST,ALT,Scr,BUN,CKB,CK-MB),coagulation function index(t-PA,PAI-1,TAT,SFMC),wound inflammatory cell(macrophages,neutrophils,lymphocytes)count,serum levels of inflammatory cytokines(TNF-α,IL-1,IL-6,hs-CRP,NF-κB)and chemokine(MCP-1,CXCL-8)in 2 groups were significantly better than before treatment(P<0.05);most indexes of observation group were significantly better than those of control group(P<0.05).No severe ADR was found in 2 groups.CONCLUSIONS:Jidesheng anti-venom tablet as auxiliary treatment can significantly reduce the local wound inflammation and systemic inflammatory response of snake bite patients;the mechanism is probably related to reducing the levels of chemokine MCP-1 and CXCL-8 and inflammatory cytokines hs-CRP and NF-κB.