二草清胰汤对急性胰腺炎患者中医证候积分及血清相关细胞因子水平的影响

Effect of Two-Herb Pancreas-Clearing Decoction on the traditional Chinese medicine syndrome score and serum cytokine levels in patients with acute pancreatitis

目的探讨二草清胰汤治疗急性胰腺炎(AP)的疗效及其对中医证候积分、炎症因子、免疫功能的影响。方法回顾性选取2023年1月至2024年4月于开封市中医院诊治的104例AP患者为研究对象,依据治疗方案分为对照组(乌司他丁+生长抑素)、研究组(乌司他丁+生长抑素+二草清胰汤治疗),各52例。观察两组临床疗效、临床症状改善情况及治疗前后中医证候积分、胃肠道功能[胃肠道症状评定量表(GSRS)]、急性胰腺炎严重程度床边指数(BISAP)、胰腺微循环障碍[胰腺血流量(BF)、血流容积(BV)、灌注达峰时间(TTP)]、炎症因子[肿瘤坏死因子-α(TNF-α)、内毒素、白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)]、免疫功能(CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+))及两组不良反应。结果与对照组总有效率75.00%比较,研究组94.23%较高(P<0.05)。研究组肠鸣音恢复时间、腹痛缓解时间、体温恢复正常时间、血清淀粉酶恢复时间短于对照组(P<0.05)。与对照组比较,研究组治疗后中医证候积分、GSRS、BISAP评分降低(P<0.05);BF、BV升高,TTP降低(P<0.05);血清TNF-α、内毒素、IL-1β、IL-18水平降低(P<0.05);CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)升高(P<0.05);两组不良反应比较差异无统计学意义(P>0.05)。结论二草清胰汤联合乌司他丁、生长抑素治疗AP患者,可提高临床疗效,改善临床症状、胰腺功能、胃肠道功能、胰腺微循环,并可减轻炎症反应,增强机体免疫力,且具有一定安全性。

Objective To investigate the efficacy of Two-Herb Pancreas-Clearing Decoction on treating acute pancreatitis(AP)and its effects on the traditional Chinese medicine(TCM)syndrome score,inflammatory factors,and immune function.Methods A retrospective study was conducted on 104 AP patients treated in the Kaifeng TCM Hospital from January 2023 to April 2024.They were divided into the control group(ulinastatin+somatostatin,n=52)and study group(ulinastatin+somatostatin+Two-Herb Pancreas-Clearing Decoction,n=52)based on the treatment plan.The clinical efficacy,improvement of clinical symptoms,TCM syndrome scores,gastrointestinal function assessed by the gastrointestinal symptom rating scale(GSRS),the bedside index of severity of acute pancreatitis(BISAP),pancreatic microcirculation disorders assessed by the pancreatic blood flow(BF),blood flow volume(BV),peak time of perfusion(TTP),inflammatory factors(Tumor Necrosis Factor-α[TNF-α],endotoxin,interleukin-1β[IL-1β],(IL-18),immune+function(CD_(3)^(+),CD4 and CD_(4)^(+)/CD_(8)^(+))were included as comparisons.Results Compared with,the total effective rate was significantly higher in the study group than that of the control group(94.23%VS 75.00%,P<0.05).The time of bowel sound recovery,abdominal pain relief,body temperature return to normal and serum amylase return to normal in the study group was significantly shorter than those in the control group(P<0.05).Compared with the control group,TCM syndrome score,GSRS,and BISAP scores after treatment were significantly lower in the study group(P<0.05).Compared with the control group,significantly higher BF and BV,and lower TTP were detected in the study group after treatment(P<0.05).Compared with the control group,serum TNF-α,endotoxin,IL-1β,and IL-18 were significantly lower,whileCD_(3)^(+),CD_(4)^(+)and+CD_(4)^(+)/CD_(8)^(+) levels were significantly higher in the study group(P<0.05).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusion Two-Herb Pancreas-Clearing decoction combined with ulinastatin and somatostatin can improve clinical efficacy,relieve clinical symptoms,improve pancreatic function and microcirculation and gastrointestinal and immune function,and reduce inflammatory response of AP with a high safety.