清肺承气颗粒对早期重症急性胰腺炎的影响  

Effect of Qingfei Chengqi granules on immune response in patients with early severe acute pancreatitis

作　　者：李静[1] 傅强[2] 祁蕾[1] 杜超[3] 余杨梓[3] 

机构地区：[1]天津医科大学中西医结合临床,天津市300070 [2]天津市第四中心医院,天津市300140 [3]天津市南开医院重症医学科,天津市300100

出　　处：《世界华人消化杂志》2014年第11期1602-1606,共5页World Chinese Journal of Digestology

基　　金：国家重点基础研究发展计划基金资助项目;No.2009CB522703~~

摘　　要：目的:观察清肺承气颗粒对重症急性胰腺炎(severe acute pancreatitis,SAP)早期免疫反应的影响,及对病死率的影响.方法:68例确诊为SAP早期的患者,随机分为观察组和对照组;观察组给予西医常规治疗+清肺承气颗粒,对照组给予西医常规治疗+安慰剂.分别于第1、3、7、14天,检测患者外周血人类白细胞抗原DR位点(human leukocyte antigen DR site,HLA-DR)表达率、T辅助淋巴细胞1/2(the helper T lymphocyte 1/2,Th1/Th2)、自然调节性T细胞(the regulatory T lymphocyte,Treg).结果:28 d内患者死亡9例(13.24%),其中观察组死亡3例(9.09%),对照组死亡6例(17.14%).观察组与对照组相比,HLA-DR表达率在第7、14天显著升高(86.77%±17.39%vs 65.46%±28.72%和85.43%±20.36%vs 73.32%±29.03%,P<0.05),Th1/Th2在第7、14天显著降低(3.58±3.74 vs 4.62±2.69和3.54±2.65vs 5.64±2.34,P<0.05),Treg阳性率在第3、7天显著升高(9.37%±5.61%vs 5.65%±3.75%和9.10%±6.86%vs 7.09%±4.80%,P<0.05).与观察组本组患者入组时相比,HLA-DR表达率第7、14天明显升高(86.77%±17.39%vs 67.71%±28.63%和85.43%±20.36%vs67.71%±28.63%,P<0.05),Th1/Th2在第7、14天显著降低(3.58±3.74 vs 5.96±6.12和3.54±2.65 vs 5.96±6.12,P<0.05),Treg阳性率在第3、7天显著升高(9.37%±5.61%vs 6.11%±4.08%和9.10%±6.86%vs 6.11%±4.08%,P<0.05),与对照组本组患者入组时相比,HLA-DR表达率在第14天显著升高(73.32%±29.03%vs 61.71%±28.77%,P<0.05).结论:清肺承气颗粒可能增强SAP早期的抗原呈递,增强免疫应答的启动,降低免疫抑制;同时可能通过Treg细胞的高表达来促进Th1向Th2细胞转化,减轻炎症反应对机体的损害来降低病死率.AIM： To observe the effect of Qingfei Chengqi granules on immune response in early severe acute pancreatitis （SAP） patients. METHODS： Sixty-eight patients with early SAP were randomly assigned to either an observation group or a control group. The observation group received Western medicine treatment plus Qingfei Chengqi granules, while the control group received Western medicine therapy plus placebo. The expression rate of human leukocyte antigen DR [HLA-DR （%）], helper T lymphocytes 1/2 （Th1/Th2） and regulatory T lymphocytes （Tregs） in peripheral blood were determined on days 1, 3, 7 and 14. RESULTS： Nine （13.24%） patients die within 28 days, including three （9.09%） in the observation group and six （17.14%） in the control group. Compared with the control group, HLA-DR （%） on days 7 and 14 （86.77% ± 17.39% vs 65.46% ± 28.72%, 85.43% ± 20.36% vs 73.32% ± 29.03%, P 〈 0.05 for both） and Tregs on days 1 and 3 （9.37% ± 5.61% vs 5.65% ± 3.75%, 9.10% ± 6.86% vs 7.09% ± 4.80%, P 〈 0.05 for both） were significantly increased, and Th1/Th2 on days 7 and 14 （3.58 ± 3.74 vs 4.62 ± 2.69, 3.54 ± 2.65 vs 5.64 ± 2.34, P 〈 0.05 for both） were significantly decreased in the observation group. Compared with pretreatment values in the observation group, HLA-DR （%） on days 7 and 14 （86.77% ± 17.39% vs 67.71% ± 28.63%, 85.43% ± 20.36% vs 67.71% ± 28.63%, P 〈 0.05 for both） and Tregs on days 1 and 3 （9.37% ± 5.61% vs 6.11% ± 4.08%, 9.10% ± 6.86% vs 6.11% ± 4.08%, P 〈 0.05） were significantly increased, and Th1/Th2 on days 7 and 14 （3.58 ± 3.74 vs 5.96 ± 6.12, 3.54 ± 2.65 vs 5.96 ± 6.12, P 〈 0.05 for both） were significantly decreased after treatment. Compared with pretreatment values in the control group, HLA-DR （%） on day 14 （73.32% ± 29.03% vs 61.71% ± 28.77%, P 〈 0.05） were significantly increased. CONCLUSION： Qingfei Chengqi granules may enhance antigen presentation and immune response to reduce immune suppression in

关 键 词：重症急性胰腺炎 清肺承气颗粒 人类白细胞抗原DR位点 T辅助淋巴细胞1 2 调节性T细胞 

分 类 号：R259[医药卫生—中西医结合]