生大黄保留灌肠联合乌司他丁对脓毒症合并MODS患者免疫内稳态及炎症水平的影响

Effect of Rhubarb Retention Enema Combined with Ulinastatin on Immune Homeostasis and Inflammation Level in Patients with Sepsis and MODS

目的分析生大黄保留灌肠联合乌司他丁对脓毒症合并多器官功能障碍综合征(MODS)患者免疫内稳态及炎症水平的影响。方法收集2018年1月至2020年12月首都医科大学附属北京友谊医院收治的145例脓毒症合并MODS患者的临床资料进行回顾性分析。按照治疗方法不同分为对照组(72例)和观察组(73例)。其中,对照组在常规治疗的基础上给予乌司他丁治疗,将100000 U的药物溶于500 ml的氯化钠注射液中,静脉滴注,每次静滴时间为1~2 h,每日3次;观察组在对照组的基础上给予生大黄保留灌肠治疗,两组均治疗1周。比较两组患者治疗前后的急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA),炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平,免疫功能指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))和心功能指标[左心室射血分数(LVEF)、N端脑钠肽前体(NT-proBNP)]变化,以及并发症发生情况。结果不同时点间、组间APACHEⅡ、SOFA的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01)。与治疗前相比,治疗后两组的APACHEⅡ、SOFA均降低,且观察组低于对照组(P<0.05)。不同时点间、组间IL-6、CRP、TNF-α水平的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01)。与治疗前相比,治疗后两组的IL-6、CRP、TNF-α水平均降低,且观察组低于对照组(P<0.05)。不同时点间、组间CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01)。与治疗前相比,治疗后两组的CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均升高,且观察组高于对照组(P<0.05)。不同时点间、组间LVEF、NT-proBNP水平的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01)。与治疗前相比,治疗后两组的LVEF均升高,且观察组高于对照组(P<0.05);NT-proBNP水平均降低,且观察组低于对照组(P<0.05)。两组的总并发症发生率比较差异无统计学意义(P>0.05)。结论生大黄保留灌肠联合乌司他丁治疗脓毒症合并MODS能明显控制患者病情进展,减轻机体炎症反应程度,提高免疫功能和心功能,同时具有较好的安全性。

Objective To analyze the effects of rhubarb retention enema combined with ulinastatin on immune homeostasis and inflammation level in patients with sepsis complicated with multiple organ dysfunction syndrome(MODS).Methods The clinical data of 145 patients with sepsis complicated with MODS admitted to Beijing Friendship Hospital,Capital Medical University from Jan.2018 to Dec.2020 were collected and analyzed retrospectively.The cases were divided into a control group(72 cases)and an observation group(73 cases)according to the treatment method.The control group was treated with ulinastatin on the basis of routine treatment,the 100000 U drug was dissolved in 500 ml sodium chloride injection and given intravenously for 1-2 h each time,3 times a day,and the observation group was treated with raw rhubarb on the basis of the control group′s plan,and both groups were treated for 1 week.The changes of scores of acute physiology and chronic health evaluation scoreⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)],immune function indexes(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),cardiac function indexes[left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP)]after treatment,and the occurrence of complications were compared between the two groups.Results The main effect differences of APACHEⅡand SOFA between different time points and groups were statistically significant(P<0.01);there were interactions between time points and groups(P<0.01).Compared with before treatment,the APACHEⅡand SOFA scores of the two groups decreased after treatment,and the scores of the observation group were lower than those of the control group(P<0.05).The main effect differences of IL-6,CRP and TNF-αbetween different time points and groups were statistically significant(P<0.01);there were interactions between time points and groups(P<0.01).Compared with before treatment,the levels of IL-6,CRP and TNF-αin the two groups decreased after treatment,and the levels in the observation group were lower than those in the control group(P<0.05).The main effect differences of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)levels between different time points and groups were statistically significant(P<0.01);there were interactions between time points and groups(P<0.01).Compared with before treatment,the levels of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in the two groups increased after treatment,and the levels in the observation group were higher than those in the control group(P<0.05).The main effect differences of LVEF and NT-proBNP levels between different time points and groups were statistically significant(P<0.01);there were interactions between time points and groups(P<0.01).Compared with that before treatment,LVEF in the two groups increased after treatment,and the LVEF in the observation group was higher than that in the control group(P<0.05);NT-proBNP in the two groups decreased,and the observation group was lower than the control group(P<0.05).There was no significant difference in the incidence of total complications between the two groups(P>0.05).Conclusion Rhubarb retention enema combined with ulinastatin in the treatment of sepsis complicated with MODS can significantly control the disease progression,reduce the degree of inflammatory reaction,improve immune function and cardiac function,and has good safety.