摘要
目的探讨四逆汤对严重脓毒症阴证患者免疫功能的影响。方法纳入严重脓毒症阴证患者50例,随机分为试验组及对照组各25例。对照组给予西医常规治疗,试验组在对照组治疗基础上予四逆汤口服或胃管注药,每日1次,疗程3天。检测两组患者治疗前后单核细胞人类白细胞抗原(mHLA-DR)水平、T淋巴细胞亚群水平、免疫指标、炎症指标、血氧分压、氧合指数及血乳酸水平,同时观察患者序贯器官衰竭评估评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、28天生存率、卫生经济学指标及安全性评价。结果治疗前后两组间免疫指标比较差异均无统计学意义(P>0.05)。试验组治疗后降钙素原、动脉血氧分压水平较对照组明显升高(P<0.01)。两组治疗后mHLA-DR、血清总补体活性、IgM均较治疗前明显升高,C反应蛋白、乳酸水平、APACHEⅡ评分均较治疗前明显降低(P<0.05或P<0.01)。试验组治疗前后的白细胞介素6水平、氧分压及氧合指数比较差异有统计学意义(P<0.01)。试验过程无药物相关不良事件。结论四逆汤能改善严重脓毒症阴证患者氧合功能及部分炎症反应,且安全性好;但尚不能证明对其免疫抑制的调节作用。
Objective To investigate the effects of Sini Decoction(四逆汤) on immune function in patients with severe sepsis of Yin syndrome. Methods A total of 50 severe sepsis patients with Yin syndrome were adopted and randomly divided into an test group and a control group with 25 cases in each group. The control group was given conventional western medicine treatment, and the test group was given Sini Decoction(四逆汤) orally or gastric tube injections on the basis of treatment in the control group, once a day for 3 days. Human leucocyte antigen-DR on monocytes(mHLA-DR) level, T lymphocyte subsets, immune function indexes, inflammatory markers, partial pressure of oxygen, oxygenation index and blood lactate levels were tested before and after treatment for both groups. Meanwhile, the sequential organ failure assessment(SOFA) score, acute physiology, and chronic health status scoring system Ⅱ(APACHE Ⅱ) score, 28-day survival rate, and health economic indicators of the patients were observed. Results There were no significant differences in the immunological indexes between the 2 groups neither before nor after treatment. After treatment, the procalcitonin(PCT) and arterial oxygen partial pressure levels of the test group in the treatment group were significantly higher than those of the control group(P<0.01). The mHLA-DR, CH50, IgM of both groups were increased after treatment, while C-reactive protein, lactic acid levels, and APACHE Ⅱ scores were significantly decreased(P<0.05 or P<0.01). There were significant differences in the levels of interleukin 6(IL-6), oxygen partial pressure, and oxygenation index before and after treatment in the test group(P<0.01). There were no drug-related adverse events during the trial. Conclusion The Sini Decoction(四逆汤) can improve oxygenation and some inflammatory reactions with safety of patients with severe sepsis and Yin syndrome, but regulating effects on the immunosuppression is not yet proven.
作者
赖芳
郑义
曾瑞峰
周耿标
张燕
麦舒桃
谢东平
翁燕娜
杜炯栋
韩云
李俊
LAI Fang;ZHENG Yi;ZENG Ruifeng;ZHOU Gengbiao;ZHANG Yan;MAI Shutao;XIE Dongping;WENG Yanna;DU Jiongdong;HAN Yun;LI Jun(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120;Foshan Hospital of Traditional Chinese Medicine,Guangdong Province)
出处
《中医杂志》
CSCD
北大核心
2020年第9期789-795,共7页
Journal of Traditional Chinese Medicine
基金
国家自然科学基金(81703856)
广东省科学技术厅项目(2014A020212280,2016A020215196)
广东省中医急症研究重点实验室(2017B030314176)
广东省中医院中医药科学技术研究专项(YN2018ZD03)
广东省中医院“优势病种”突破专项:脓毒症优势病种
晁恩祥名中医药专家传承工作室。
关键词
脓毒症
阴证
四逆汤
免疫调节
随机对照试验
sepsis
Yin syndrome
Sini Decoction(四逆汤)
immunomodulation
randomized controlled trial
