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目的:探讨大承气汤联合乌司他丁对脓毒症合并多脏器功能衰竭综合征患者血清中降钙素原、C反应蛋白及免疫功能的影响。方法:选择2011年3月—2014年3月脓毒症合并多脏器功能衰竭综合征患者40例,随机分为两组,乌司他丁组(UTI组)和大承气汤联合UTI治疗组(联合治疗组),每组20例,评价患者疾病严重程度评分(APACHEII评分)及感染性炎性反应评分(SOFA评分)。在入院24 h内及接受治疗7 d后,测定两组患者血清降钙素原、C-反应蛋白、白细胞计数以及血清中IL-4,IL-6,IL-10,IL-12,IL-18,IFN-r的含量,并采用流式细胞术检测患者血液中CD4+、CD8+T淋巴细胞数以及CD4+/CD8+的比值。结果:两组患者在年龄和性别上无统计学差异(P>0.05),在治疗前两组患者的APACHEII评分和SOFA评分无统计学差异(P>0.05),具有可比性。在UTI组和联合治疗组在治疗前APACHEII评分分别为(27.8±6.32)分和(28.1±3.77)分,经治疗后分别降低为(22.41±3.37)分和(19.83±4.43)分,与治疗前相比差异有统计学意义(t=3.78,4.31,P<0.05)。治疗前两组的SOFA评分分别为(15.57±4.54)分和(16.39±5.57)分,治疗后分别下降至(11.4±4.61)分和(9.97±3.43)分,与治疗前比较,差异有统计学意义(t=2.98,4.51,P<0.05);治疗后,两组患者血清中PCT、CPR及WBC的测定值均降低,与治疗前比较,差异有统计学差异(P<0.05,P<0.01),且联合治疗组患者血清中PCT、CPR及WBC的测定值均低于UTI组,且差异有统计学差异(P<0.05,P<0.01)。治疗后,两组患者血清中炎症因子IL-4、IL-6、IL-10、IL-12、IL-18和IFN-r的水平均有不同程度的下降,与治疗前比较,IL-4、IL-6、IL-12的水平有统计学差异(P<0.05,P<0.01)。联合治疗组,在治疗前血清中IL-4和IL-6的含量分别为(75.98±8.34)ng/m L和(71.95±6.67)ng/m L,治疗后(34.51±6.12)ng/m L和(22.47±9.93)ng/m L,与治疗前相比差异有显著意义(P<0.01),与UTI组相比,差异有统计学意义(P<0.05)。两组患者采用不同方法治疗后,CD8+T淋巴细胞数无变化,但采用UTI治疗后,CD4+T淋巴细胞百分比分别由(33.17±3.87)%增加至(47.13±4.41)%,CD4+/CD8+的值由(1.25±0.45)增加至(1.84±0.34),且差异有统计学意义(P<0.05)。采用大承气汤和UTI联合治疗后,CD4+T淋巴细胞百分比分别由(32.96±3.45)%增加至(53.29±3.31)%,且差异有统计学意义(P<0.05),CD4+/CD8+的值由(1.24±0.33)增加至(2.15±0.17),且有显著差异(P<0.01)。结论:大承气汤联合UTI可以有效治疗脓毒症合并MODS,且能够提高患者的免疫功能,在临床使用中值得推广。
Objective: To investigate the effect of Dachengqi Decoction combined with ulinastatin on serum procalcitonin, C-reactive protein and immune function in patients with sepsis complicated with multiple organ failure syndrome. Methods: From March 2011 to March 2014, 40 patients with sepsis complicated with multiple organ failure syndrome were randomly divided into two groups: Ulinastatin group (UTI group) and Dachengqi Decoction combined with UTI Group (combined treatment group), 20 cases in each group. The patient’s disease severity score (APACHEII score) and infectious inflammatory response score (SOFA score) were evaluated. Serum procalcitonin, C-reactive protein, leukocyte counts and serum levels of IL-4, IL-6, IL-10, IL-12 and IL-12 were measured within 24 hours of admission and after 7 days of treatment. 18, IFN-r, and the flow cytometry in patients with blood CD4 +, CD8 + T lymphocytes and CD4 + / CD8 ratio. Results: There was no significant difference between the two groups in age and gender (P> 0.05). There was no significant difference in APACHEII score and SOFA score between the two groups before treatment (P> 0.05). APACHEII scores before treatment in the UTI group and the combination therapy group were (27.8 ± 6.32) and (28.1 ± 3.77) points, respectively, and were decreased to (22.41 ± 3.37) points and (19.83 ± 4.43) points respectively after treatment, Before the difference was statistically significant (t = 3.78,4.31, P <0.05). The SOFA scores of the two groups before treatment were (15.57 ± 4.54) and (16.39 ± 5.57) points, respectively, and decreased to (11.4 ± 4.61) and (9.97 ± 3.43) points after treatment, respectively, with statistical differences (T = 2.98, 4.51, P <0.05). After treatment, the serum PCT, CPR and WBC values decreased in both groups, with statistical significance (P <0.05, P < 0.01). The serum PCT, CPR and WBC in the combined treatment group were lower than those in the UTI group, and the difference was statistically significant (P <0.05, P <0.01). After treatment, the levels of IL-4, IL-6, IL-10, IL-12, IL-18 and IFN-γ in the serum of the two groups decreased to some extent. , IL-6, IL-12 levels were statistically different (P <0.05, P <0.01). In the combination therapy group, the levels of IL-4 and IL-6 in serum before treatment were (75.98 ± 8.34) ng / m L and (71.95 ± 6.67) ng / m L respectively, and were 34.51 ± 6.12 ng / m L and (22.47 ± 9.93) ng / m L, respectively, which were significantly different from those before treatment (P <0.01). There was a significant difference between the two groups (P <0.05). The percentage of CD4 + T lymphocytes increased from (33.17 ± 3.87)% to (47.13 ± 4.41)%, and the percentage of CD4 + / CD8 + T lymphocytes increased after treatment with UTI in both groups. Value increased from (1.25 ± 0.45) to (1.84 ± 0.34), and the difference was statistically significant (P <0.05). The percentage of CD4 + T lymphocytes increased from (32.96 ± 3.45)% to (53.29 ± 3.31)% with Dachengqi Decoction combined with UTI, the difference was statistically significant (P <0.05). The percentage of CD4 + / CD8 + Value increased from (1.24 ± 0.33) to (2.15 ± 0.17), and there was a significant difference (P <0.01). Conclusion: Dachengqi Decoction combined with UTI can effectively treat sepsis combined with MODS, and can improve the immune function of patients, worth promoting in clinical use.