扶正逐瘀泻火汤结合西医常规疗法治疗急性胰腺炎瘀毒互结证临床研究

Clinical study on Fuzheng Zhuyu Xiehuo Decoction combine with conventional western medicine therapy in the treatment of acute pancreatitis of intermingled blood stasis-toxin syndrome

目的探讨扶正逐瘀泻火汤对急性胰腺炎(acute pancreatitis,AP)瘀毒互结证患者疗效及外周血炎性细胞因子、微循环指标的影响。方法将符合入选标准的2019年3月-2020年3月湖南中医药大学第一附属医院脾胃病科与邵阳市中心医院消化内科AP患者100例,采用随机数字表法分为2组,每组50例。对照组予以西医常规疗法治疗,观察组在对照组基础上加服扶正逐瘀泻火汤。分别于治疗前后进行中医证候评分,采用急性生理和慢性健康状况评分Ⅱ(Acute Physiology And Chronic Health EvaluationⅡ,APACHEⅡ)评估疾病严重程度,采用ELISA法检测IL-6、IL-8、TNF-α及血栓素A2(thromboxane A2,TXA2)、前列环素(prostaglandin I_(2),PGI_(2))、血小板活化因子(platelet activating factor,PAF)水平,比较2组腹痛、腹胀、发热、胃肠功能恢复时间及住院时间,记录不良反应,评价临床疗效。结果观察组总有效率为96.0%(48/50)、对照组为84.0%(42/50),2组比较差异有统计学意义(χ^(2)=4.00,P=0.045)。观察组治疗后腹痛、腹胀、发热、恶心呕吐评分低于对照组(t值分别为7.07、7.06、11.47、10.30,P值均<0.01),腹痛、腹胀、发热、胃肠功能恢复时间及住院时间均短于对照组(t值分别为4.52、4.90、6.27、6.55、7.12,P<0.01)。治疗后,观察组血清IL-6[(30.15±7.04)μg/L比(42.37±8.29)μg/L,t=7.95]、IL-8[(39.36±8.11)μg/L比(50.36±10.47)μg/L,t=5.87]、TNF-α[(106.28±21.04)μg/L比(153.45±30.23)μg/L,t=9.06]水平低于对照组(P<0.01);血清TXA2[(223.68±40.15)ng/L比(257.11±50.32)ng/L,t=3.67]、PAF[(74.86±15.37)ng/L比(85.53±15.26)ng/L,t=3.48]水平低于对照组(P<0.01),PGI_(2)[(91.43±17.45)ng/L比(76.49±15.13)ng/L,t=4.57]水平高于对照组(P<0.01)。结论扶正逐瘀泻火汤结合西医常规疗法可有效改善AP瘀毒互结证患者的临床症状及血液微循环状态,减轻炎症反应,提高临床疗效。

Objective To explore the efficacy of Fuzheng Zhuyu Xiehuo Decoction for the patients with acute pancreatitis(AP)of intermingled blood stasis-toxin syndrome and its influence on peripheral blood inflammatory factors and microcirculation indicators.Methods A total of 100 patients with AP,admitted to department of spleen and stomach diseases of the First Affiliated Hospital of Hunan University of Chinese Medicine and department of gastroenterology of the Central Hospital of Shaoyang,who met the inclusion criteria between March 2019 and March 2020,were divided into two groups according to the random number table method,with 50 in each group.The control group was given conventional western medicine,while the observation group was treated with Fuzheng Zhuyu Xiehuo Decoction on the basis of the control group.The TCM syndromes were scored before and after treatment,and Acute Physiology and ChronicHealth EvaluationⅡ(APACHEⅡ)was used to evaluate the severity of the disease,and ELISA was adopted to detect the levels of IL-6,IL-8,TNF-αand thromboxane A2(TXA2),prostaglandin I_(2)(PGI_(2))and platelet activating factor(PAF).The abdominal pain,abdominal distension,fever,gastrointestinal function recovery time and hospital stay were observed and the adverse events were recorded.Results The total effective rate was 96.0%(48/50)in the observation group and that of the control group was 84.0%(42/50)(χ^(2)=4.00,P=0.045).The scores of abdominal pain,abdominal distension,fever and nausea and vomiting in observation group were significantly lower than those in the control group(t=7.07,7.06,11.47,10.30,all Ps<0.01),and the recovery times of abdominal pain,abdominal distension,fever and gastrointestinal function and hospital stay in the observation group were significantly shorter than those in the control group(t=4.52,4.90,6.27,6.55,7.12,all Ps<0.01).After treatment,the levels of serum IL-6[(30.15±7.04)μg/L vs.(42.37±8.29)μg/L,t=7.95],IL-8[(39.36±8.11)μg/L vs.(50.36±10.47)μg/L,t=5.87],TNF-α[(106.28±21.04)μg/L vs.(153.45±30.23)μg/L,t=9.06]in the observation group were significantly lower than those in the control group(P<0.01).The serum TXA2[(223.68±40.15)ng/L vs.(257.11±50.32)ng/L,t=3.67]and PAF[(74.86±15.37)ng/L vs.(85.53±15.26)ng/L,t=3.48]in the observation group were significantly lower than those in the control group(P<0.01)while the level of PGI_(2)[(91.43±17.45)ng/L vs.(76.49±15.13)ng/L,t=4.57]in the observation group was significantly higher than those in the control group(P<0.01).Conclusion Fuzheng Zhuyu Xiehuo Decoction combined with western medicine can improve clinical symptoms and blood microcirculation status,relieve inflammatory response and enhance clinical efficacy of patients with AP of intermingled blood stasis-toxin syndrome.