大承气冲剂对腹腔感染致急性肺损伤患者巨噬细胞的作用  

The Effect of Dachengqi Granule on Alveolar Macrophages in Patients Suffering from Intra-abdominal Infection with Acute Lung Injury

作　　者：宋媛[1] 解基良[1] 张楠[1] 单涛[1] 闫瑞鹏[1] 张兴洲[1] 桑伟岗 

机构地区：[1]天津市南开医院,天津300100

出　　处：《中国中西医结合外科杂志》2015年第6期547-552,共6页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市卫生局科技基金资助项目(11KG129)

摘　　要：目的:研究大承气冲剂对腹腔感染致急性肺损伤(ALI)患者肺泡巨噬细胞(AMs)的影响。方法:观察严重腹腔感染合并ALI成年患者60例,随机分为中药组(30例)和对照组(30例),对照组给予西医常规治疗合用安慰剂,中药组给予西医常规治疗合用大承气冲剂,疗程为5 d,分别于第1、3、5 d记录患者排气排便时间、尿乳果糖/甘露醇比值(尿L/M)、氧合指数(OI),并采集肺泡灌洗液,利用流式细胞仪定量检测肺泡灌洗液中AMs水平及其亚型M1、M2的百分比。结果:中药组和对照组尿L/M值均随时间延长下降,第5 d分别为3.97±1.53,7.01±2.44,中药组患者较对照组下降更明显(P<0.05);第5 d中药组和对照组OI分别为255.44±18.18,222.76±15.15,中药组明显升高(P<0.05)。在两组患者随治疗进展腹腔感染所致肠功能障碍与ALI严重程度不断减轻的同时,中药组其肠功能、肺功能改善的程度优于对照组,且有明显的差异(P<0.05)。比较治疗5 d后两组患者数据,AMs百分比分别为(92.65±1.06)%和(94.82±0.90)%,M1百分比为(42.17±6.99)%和(55.49±6.26)%,中药组均较对照组明显降低(P<0.05),M2百分比则为(44.72±5.36)%,(35.09±7.37)%,中药组患者较对照组明显升高(P<0.05)。各组内AMs、M1及M2比例随肠功能、肺功能改善而分别见回落及升高趋势,均充分提示了AMs水平、M1比例下降及M2升高在严重腹腔感染合并ALI患者病理生理过程中的重要作用。结论:在腹腔感染致ALI的早期,应用大承气冲剂可有效减少AMs激活、聚集,降低M1比例,促进M2生成,从而减轻炎症反应,减轻肺损伤,保护肠黏膜屏障功能。ObjectiveTo study the effect of Dachengqi granule on alveolar macrophages of patients suffer-ing from intra-abdominal infection（IAI） combined with acute lung injury（ALI）.MethodsWith observationof severe IAI complicating ALI in adult patients,60 cases were randomly divided into two groups—chinesemedicine group（30 cases） and control group（30 cases）, the symptoms and signs were observed. The controlgroup was given conventional western medicine treatment and a placebo, chinese medicine group was given con-ventional western medicine treatment and combined with Dachengqi granule. The treatmenta were implementedfor five days. In 1, 3, 5 days, we recorded the time of exhaustion and defecation, the ratio of lactuloseto mannitolin urine（L/M ratio） and oxygenation index value（OI）. We collect bronchoalveolar lavage fluid lines each index de-tection. Quantitative detection by flow cytometry instrument was used to detect the levels of bronchoalveolar la-vage fluid in alveolar macrophages and percentage of subtype M1 and M2.ResultsWith the extension oftime, two groups of urine L/M ratio were both going down,and at the 5th day, they were 3.97±1.53,7.01±2.44,compared with the control group patients,chinese medicine group was more obviously（P〈0.05）;OI of twogroups at the 5th day are 255.44±18.18,222.76±15.15,chinese medicine group obviously increased（P〈0.05）.In the advance, in the treatment of two groups of patients with bowel dysfunction caused by IAI and ALI, the se-verity was continuously reduced. At the same time,the chinese medicine treatment improved the degreeof the bowel function and lung function is better thanthat of control treatment, and there is obvious difference（P〈0.05）. Comparing two groups of patients data afterfive days treatment, AMs percentage are（92.65±1.06）% and 94.82±0.90%, proportion of M1 are（42.17±6.99）%and（55.49±6.26）%, chinese medicine group obviously decline（P〈0.05）;besides, proportion of M2 are（44.72±5.36）% and（35.09±7.37）

关 键 词：大承气冲剂 腹腔感染 急性肺损伤 肺巨噬细胞 

分 类 号：R655.3[医药卫生—外科学]