解毒益气活血方改善严重脓毒症患者免疫功能的机制研究(1)
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摘 要：目的：探讨解毒益气活血方对严重脓毒症患者免疫功能的影响及临床疗效。方法：选择ICU严重脓毒症患者63例，随机分为对照组(31例，采用西医治疗)和治疗组(32例，采用西医治疗加解毒益气活血方)。分析比较两组患者治疗前及治疗后5、10天相关免疫学指标、APACHEⅡ评分、机械通气时间、住ICU时间及28天病死率的情况。结果：与对照组相比，治疗组治疗后TNF-α、IL-6、IL-10明显下降，IgG水平、淋巴细胞计数、CD+4T淋巴细胞水平及CD+14单核细胞HLA-DR表达明显上升，住ICU时间明显缩短，28天病死率明显下降(P<0.05或P<0.01)。结论：解毒益气活血方结合西医治疗能调节患者的免疫功能，改善严重脓毒症患者病情和预后。
关键词：严重脓毒症；细胞因子；体液免疫；细胞免疫；解毒益气活血方
中图分类号：R593
文献标识码：B
文章编号：1673-7717(2012)04-0760-03
Study on Mechanism of Jiedu Yiqi Huoxue Recipe Improving Immune Function of Severe Septic Patients
WU Yan-chun，WANG Ling-cong，YUAN Xin-wang，LEI Shu，ZHI Yi-hui，JIANG Rong-lin
(The First Affiliated Hospital of Zhejiang Chinese Medical University，Hangzhou，310006，Zhejiang，China)
Abstract:Objective：To explore the effect on immunologic function and the therapeutic efficacy of Jiedu Yiqi Huoxue Recipe(JYHR)treating severe sepsis. Methods：Sixty-three patients with severe sepsis in intensive care unit(ICU)were enrolled and randomly assigned to two groups. Thirty-one patients in the control group were treated with western medicine alone，thirty-two patients in the therapy group were treated with western medicine combined with JYHR. Changes of the immune index and APACHE Ⅱ score before and after therapy in the 5th，7th day，the duration of mechanical ventilation，ICU stay time and 28-day mortality were monitored and compared.Results：Compared with the control group，levels of TNF-α，IL-6 and IL-10，ICU stay time and 28-day mortality were significantly lower in the therapy group(P<0.05 or P<0.01)，IgG level，the lymphocytes，CD+4 T lymphocytes and level of CD+14 monocytes HLA-DR in the therapy group increased significantly(P<0.05 or P<0.01). Conclusion：JYHR combined with western medicine can regulate the immunologic function and improve illness state and the outcome of severe sepsis.
Key words:severe sepsis；cytokine；cellular immunity；humoral immunity；Jiedu Yiqi Huoxue Recipe
脓毒症(sepsis)是危重症患者死亡的主要原因之一，脓毒症发病率以每年1.5%～9%的速度增长，严重脓毒症死亡率高达30%～50%[1]，降低脓毒症导致的死亡是临床医师面临的共同难题。机体炎症反应和免疫功能紊乱是脓毒症和多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)发生发展的中心环节。本研究通过观察解毒益气活血方对严重脓毒症患者炎症因子、体液免疫和细胞免疫的影响 ......
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