腹炎消方辅助治疗对重症急性胰腺炎患者炎性反应及免疫功能的影响

Effects of Fuyanxiao Formula on inflammatory response and immune function in patients with severe acute pancreatitis

目的观察腹炎消方辅助治疗重症急性胰腺炎(SAP)的临床疗效及对患者炎症因子、免疫功能的影响。方法将64例SAP患者按照随机数字表法分为2组,对照组32例予西医常规治疗,治疗组32例在对照组基础上联合腹炎消方辅助治疗。2组均治疗14天后统计疗效,比较2组治疗后临床症状腹痛缓解时间、腹胀缓解时间、肠鸣音恢复时间及首次排便时间情况,比较2组治疗后血淀粉酶及白细胞计数恢复到正常水平时间,比较2组治疗前后炎症因子指标[血清肿瘤坏死因子α(TNF-α)、白细胞介素8(IL-8)及IL-6]、T淋巴细胞亚群(包括CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+))水平变化情况,比较2组治疗前后急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、改良CT严重指数(MCTSI)评分及Marshall评分变化情况,比较2组总的住院时间及住院费用情况。结果治疗组总有效率93.8%(30/32),对照组总有效率71.9%(23/32),治疗组总有效率高于对照组(P<0.05)。治疗组治疗后临床症状腹痛缓解时间、腹胀缓解时间、肠鸣音恢复时间及首次排便时间均短于对照组(P<0.05),血淀粉酶及白细胞计数恢复正常时间均短于对照组(P<0.05)。与本组治疗前比较,2组治疗后炎症因子指标血清TNF-α、IL-6及IL-8水平均降低(P<0.05),且治疗组治疗后血清TNF-α、IL-6及IL-8水平均低于对照组(P<0.05)。与本组治疗前比较,治疗组治疗后T淋巴细胞亚群CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)水平均升高(P<0.05),CD8^(+)水平均降低(P<0.05),对照组治疗后仅CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)水平均升高(P<0.05),且治疗组治疗后CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)水平均高于对照组(P<0.05),CD8^(+)水平低于对照组(P<0.05)。与本组治疗前比较,2组治疗后病情严重程度APACHEⅡ评分、MCTSI评分及Marshall评分均降低(P<0.05),且治疗组治疗后APACHEⅡ评分、MCTSI评分及Marshall评分均低于对照组(P<0.05)。治疗组总住院时间短于对照组,比较差异有统计学意义(P<0.05),但住院费用与对照组比较差异无统计学意义(P>0.05)。结论腹炎消方辅助治疗SAP临床疗效确切,可有效促进患者胃肠功能恢复,改善临床症状,控制病情进展,促进患者康复,缩短住院时间,其作用机制可能是与降低炎症因子TNF-α、IL-6及IL-8水平,抑制炎性反应,恢复T淋巴细胞亚群比例平衡,提高机体免疫功能有关。

Objective To investigate the effects of Fuyanxiao Formula on inflammatory response and immune function in patients with severe acute pancreatitis(SAP).Methods Sixty-four SAP patients were randomly in 1:1 radio assigned to receive either routine Western medicine(the control group)or routine Western medicine^(+)Fuyanxiao Formula(the treatment group).A 14-day treatment was performed to compare remission duration of abdominal pain and abdominal distension,bowel sounds recovery time,first defecation time,the time of recovery of blood amylase and white blood cell(WBC)count,inflammatory factors(serum tumor necrosis factor alpha[TNF-α],interleukin 8(IL-8),IL-6),T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores,modified CT severity index score(MCTSI),Marshall score,total length of hospital stay,hospitalization cost.The curative effect was assessed.Results The overall effective rate in the treatment group was better than that in the control group(93.8%[30/32]vs 71.9%[23/32],[P<0.05],respectively).After treatment,the remission duration of abdominal pain and abdominal distension,bowel sounds recovery time,first defecation time,the time of recovery of blood amylase and WBC count in the treatment group were significantly shorter than those in the control group(all P<0.05).TNF-α,IL-6 and IL-8 after treatment in groups were significantly decreased(P<0.05),which decreased notably in the treatment group compared with the control group(P<0.05).After treatment,significantly increased CD3^(+),CD4^(+),CD4^(+)/CD8^(+),and decreased CD8^(+)were significantly detected in the treatment group(all P<0.05),significantly increased CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were detected in the control group(P<0.05),and the treatment group was superior to the control group for CD3^(+),CD4^(+),CD4^(+)/CD8^(+),CD8^(+)(all P<0.05).After treatment,the scores of APACHEⅡ,MCTSI,Marshall in groups were significantly decreased(P<0.05),the decrease was more common in the treatment group than the control group(P<0.05).The total length of hospital stay in the treatment group was significantly shorter than that in the control group(P<0.05).None of the hospitalization cost differed significantly between groups(P>0.05).Conclusion For SAP patients,Fuyanxiao Formula has definite clinical efficacy,which can effectively promote gastrointestinal function recovery,improve clinical outcomes,control disease progression,promote patient recovery,and shorten hospitalization time by reducing TNF-α,IL-6 and IL-8 levels,inhibiting inflammatory reactions,correcting the balance of the percent of T lymphocyte subsets,and improving the body's immune function.