针药结合疗法对脓毒症患者肠道屏障功能保护作用的临床研究

Clinical study on the protection effect of intestinal barrier function in sepsis patients by combination of acupuncture and Chinese medicine

目的观察针刺联合中药口服治疗脓毒症胃肠功能障碍患者的临床疗效及其作用机制.方法选择北京中医药大学深圳医院(龙岗)2020年12月1日至2022年6月30日收治的40例脓毒症胃肠功能障碍患者作为研究对象.按随机数字表法将患者分为西医常规治疗组和针药结合疗法组,每组20例.所有患者均参照2016年脓毒症3.0指南标准给予基础治疗.西医常规治疗组在基础治疗的同时联合使用莫沙必利、复方消化酶、双歧杆菌三联活菌肠溶胶囊口服.针药结合疗法组在基础治疗的同时联合腹针疗法及温脾汤内服.腹针疗法采用薄氏腹针疗法,取穴大横、关门、天枢、太乙、气海、关元、中脘、下脘,每日1次,每次20 min,连续8d.温脾汤药物组成为大黄12 g、当归15 g、干姜10 g、制附子10 g、人参15 g、炒白术15 g、茯苓15 g、芒硝3g、炙甘草6g,口服或鼻饲,每日3次,连服8d.比较两组治疗前和治疗后4d、8d胃肠功能障碍评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)以及白细胞计数(WBC)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、脂多糖(LPS)、白细胞介素(IL-10、IL-6)、肠脂肪酸结合蛋白(I-FABP)、单核细胞人白细胞抗原-DR(HLA-DR)和辅助性T细胞17/调节性T细胞(Th17/Treg)水平的差异.结果随治疗时间延长,两组治疗后胃肠功能障碍评分、APACHEⅡ评分、WBC、hs-CRP、PCT、TNF-α、LPS、IL-6、Th17、Th17/Treg、I-FABP均较治疗前明显降低,IL-10和Treg均较治疗前明显升高,于治疗后8d达到谷值或峰值,且针药结合疗法组的变化较西医常规治疗组更显明[胃肠功能障碍评分(分):0.70±0.66比1.35±0.67,APACHEⅡ评分(分):14.70±3.92比16.90±5.17,WBC(×10^(9)/L):8.81±1.78比8.82±1.54,hs-CRP(mg/L):65.60±27.23比88.56±30.84,PCT(μg/L):1.08±1.03比1.85±1.06,TNF-α(ng/L):30.51±2.92比33.40±4.13,LPS(EU/L):28.71±2.75比32.90±2.28,IL-6(ng/L):9.81(4.88,31.60)比89.36(18.38,119.44),IL-10(ng/L):69.85±7.94比64.44±7.99,Th17/Treg:0.52±0.08比0.63±0.12,HLA-DR:(79.71±5.70)%比(74.60±5.45)%,I-FABP(ng/L):9.93±3.21比13.36±4.51,均P<0.05].结论针药结合疗法能改善脓毒症胃肠功能障碍患者的临床症状,其作用可能通过保护肠道机械屏障、减少内毒素释放和纠正免疫紊乱而实现.

Objective To observe the clinical efficacy and mechanism of acupuncture combined with Chinese medicine in the treatment of gastrointestinal dysfunction in sepsis.Methods A total of 40 patients with sepsis and gastrointestinal dysfunction admitted to Shenzhen Hospital,Beijing University of Chinese Medicine from December 1,2020 to June 30,2022 were selected as research objects.According to the random number table,the patients were divided into a Western medicine conventional treatment group and acupuncture combined with Chinese medicine treatment group,with 20 patients in each group.All patients received basic treatment according to the 2016 sepsis guidelines 3.0(2016).The Western medicine control group was treated with a combination of mosapride,compound digestive enzyme,and bifidobacterium triple viable enteric coated capsules while receiving basic treatment.Acupuncture combined with Chinese medicine group was given abdominal acupuncture combined with Wenpi decoction based on routine treatment.Abdominal acupuncture therapy adopts Bo's abdominal acupuncture therapy,taking acupoints Daheng,Guanmen,Tianshu,Taiyi,Qihai,Guanyuan,Zhongwan,and Xiawan once a day for 20 minutes each time for 8 consecutive days.The composition of Wenpi decoction includes Rhubarb 12 g,Angelica sinensis 15 g,Dried ginger 10 g,Prepared aconite 10 g,Ginseng 15 g,Fried atractylodes macrocephala 15 g,Poria cocos 15 g,Mirabilite 3 g,and Roasted licorice 6 g.It was orally or nasally fed 3 times a day for 8 consecutive days.The differences of various indicators between the two groups before treatment,4 days after treatment,and 8 days after treatment were compared,including gastrointestinal dysfunction score,the acute physiology and chronic health evaluation I(APACHE I),white blood cell count(WBC),hypersensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),and tumor necrosis factor-α(TNF-α),lipopolysaccharide(LPS),interleukins(IL-10,IL-6),intestinal fatty acid binding protein(I-FABP),monocyte human leukocyte antigen-DR(HLA-DR),and T helper cell 17/regulatory T cell(Th17/Treg).Results With the extension of treatment,the gastrointestinal dysfunction score,APACHE II score,WBC,hs-CRP,PCT,TNF-α,LPS,IL-6,Th17,Th17/Treg,I-FABP were significantly reduced compared to before treatment,while IL-10 and Treg were significantly increased compared to before treatment.These indicators reached a trough or peak at 8 days after treatment,and the changes in the acupuncture combined with Chinese medicine treatment group were more significant than those in the Western medicine control group[gastrointestinal dysfunction score:0.70±0.66 vs.1.35±0.67,APACHE I score:14.70±3.92 vs.16.90±5.17,WBC(×10^(9)/L):8.81±1.78 vs.8.82±1.54,hs-CRP(mg/L):65.60±27.23 vs.88.56±30.84,PCT(μg/L):1.08±1.03 vs.1.85±1.06,TNF-α(ng/L):30.51±2.92 vs.33.40±4.13,LPS(EU/L):28.71±2.75 vs.32.90±2.28,IL-6(ng/L):9.81(4.88,31.60)vs.89.36(18.38,119.44),IL-10(ng/L):69.85±7.94 vs.64.44±7.99,Th17/Treg:0.52±0.08 vs.0.63±0.12,HLA-DR:(79.71±5.70)%vs.(74.60±5.45)%,I-FABP(ng/L):9.93±3.21 vs.13.36±4.51,all P<0.05].Conclusion The combination of acupuncture and Chinese medicine therapy can improve the clinical symptoms of sepsis patients with gastrointestinal dysfunction,and its effect may be achieved by protecting the intestinal mechanical barrier,reducing endotoxin release,and correcting immune disorders.