犀角地黄汤加味通过清除IL-6和TNF-α改善重症肺炎机械通气患者的炎症反应机制研究

Modified Xijiao Dihuang Decoction Improves the Inflammatory Response of Mechanically Ventilated Patients with Severe Pneumonia by Eliminating IL-6 and TNF-α

目的探究犀角地黄汤加味通过清除白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)改善重症肺炎机械通气患者炎症反应的作用机制。方法患者80例随机分为对照组与研究组各40例。对照组采用常规治疗措施,研究组在对照组的基础上口服犀角地黄汤加味。两组患者均于治疗前及治疗2周后,采集全血标本进行检测,并进行临床疗效评估。结果治疗后,两组外周血Th1和Th17含量均较治疗前明显降低(P<0.05),而Th2和Treg含量明显升高(P<0.05);且治疗后研究组外周血Th1、Th17含量低于对照组(P<0.05),同时Th2、Treg含量明显高于对照组(P<0.05)。两组患者血清白细胞介素-4(IL-4)、γ干扰素(IFN-γ)、IL-6、TNF-α、白细胞介素-17(IL-17)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)水平均较治疗前降低(P<0.05),同时血清TGF-β水平升高(P<0.05);且研究组血清IL-6、TNF-α、IL-17、hs-CRP、PCT水平低于对照组(P<0.05)。两组患者APACHEⅡ评分、CPIS、PSI评分均较治疗前显著降低(P<0.05),且研究组患者低于对照组(P<0.05)。研究组患者平均ICU住院时间、机械通气时间、呼吸机相关性肺炎发生率以及肺部湿啰音、肺部致密影等临床症状恢复时间均短于对照组(P<0.05)。结论犀角地黄汤联合西医常规治疗可以通过清除IL-6、TNF-α等炎性介质改善重症肺炎机械通气患者的临床症状,缩短机械通气时间。

Objective:To explore the mechanism of Modified Xijiao Dihuang Decoction by eliminating interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)to improve the inflammatory response of mechanically ventilated patients with severe pneumonia.Methods:80 patients of severe pneumonia were selected and divided into control group and study group,40 cases in each group.The control group took conventional treatment measures,and the study group took Modified Xijiao Dihuang Decoction orally on the basis of the control group.The whole blood samples of both groups before treatment and after 2 weeks of treatment were collected for the detection,and the clinical efficacy was evaluated.Results:After treatment,the contents of Th1 and Th17 in peripheral blood and serum IL-6,TNF-α,IL-17,high-sensitivity C-reactive protein(hs-CRP)and procalcitonin(PCT)levels in the study group were lower than those in the control group after treatment;at the same time,Th2 and Treg contents were significantly higher than the control group(P<0.05).In addition,according to Acute Physiology,Age and Chronic Health EvaluationⅡscale(APACHEⅡ),clinical pulmonary infection score(CPIS)and pneumonia severity index(PSI),the clinical efficacy of the study group were better than those of the control group(P<0.05),and ICU hospitalization time,mechanical ventilation time,lung moist rales or lung dense shadow recovery time were shorter than the control group(P<0.05).The patients in the study group had lower incidence of aspiration-associated pneumonia than the control group(P<0.05).Conclusion:Modified Xijiao Dihuang Decoction combined with conventional western medicine treatment can improve the clinical symptoms of mechanically ventilated patients with severe pneumonia by eliminating IL-6,TNF-a and other inflammatory mediators,and shorten the time of mechanical ventilation.