铜绿假单胞菌感染所致肺炎炎症“瀑布效应”的发生机理与扶正解毒化瘀方的治疗  

The mechanism of 'Cascade Reaction'for pneumonia Inflammation due to pseudomonas aeruginosa infection and the treatment of the prescription of FuzhengJieduHuayu

作　　者：徐红日[1,2] 马洁[3] 常桂娇[4] 姚兴伟[4] 马林沁 王兰[1,2] 赵世同[3] 林英[4] 刘国星[3] 王玉婷[3] 王红平 韩思维 王成祥[2,5] Xu Hongri;Ma Jie;Chang Guijiao;Yao Xingwei;Ma Linqin;Wang Lan;Zhao Shitong;Lin Ying;Liu Guoxing;Wang Yuting;Wang Hongping;Han Siwei;Wang Chengxiang(Department of Emergency （ Intensive Care Unit）, Dongzhimen Hospital, Beijing University of Chinese Medicine Beijing 100700;Research Institute of Fever attached to Dongzhimen Hospital, Beijing Uni- versity of Chinese Medicine;Beijing University of Chinese Medicine;Department of Clinical Labora- tory, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine;Department of Respira- tory, Third Affiliated Hospital of Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学东直门医院急诊科(ICU),北京100700 [2]北京中医药大学东直门医院热病研究所,北京100700 [3]北京中医药大学 [4]北京中医药大学东直门医院检验科,北京100700 [5]北京中医药大学第三附属医院呼吸科

出　　处：《现代中医临床》2018年第3期44-48,共5页Modern Chinese Clinical Medicine

基　　金：国家自然科学基金(No.81573924);高等学校博士学科点专项科研基金(No.20130013120004);北京中医药传承"双百工程"项目;北京中医药大学东直门医院2016青苗人才计划项目(No.DZMYS-201608)

摘　　要：铜绿假单胞菌是引起医院内感染常见的条件致病菌之一,具有检出率高、耐药性强、致死率高等特点。多重耐药铜绿假单胞菌感染所致的肺炎治疗难度大、预后差、病死率高,已成为临床医学抗感染领域最棘手的问题之一,亟待解决。铜绿假单胞菌致病的核心机制之一在于脂多糖通过Toll样受体4信号转导通路激发炎症"瀑布效应",可导致脓毒症,甚至脓毒性休克。肺炎属于中医风温肺热病的范畴,"正气亏虚、热邪炽盛,毒瘀互结"的病机贯穿在风温肺热病的始终。我院热病课题组发现扶正解毒化瘀方切合这一病机,并对铜绿假单胞菌感染所致的肺炎疗效确切。其机制可能与该治法方药抑制铜绿假单胞菌感染所致的炎症损伤、促进炎症损伤的修复、延缓或抑制甚至可能逆转铜绿假单胞菌的耐药、与抗生素协同抑菌等有关。Pseudomonas aeruginosa is one of the most common resistant pathogen of nosocomial infection,which has the characteristics of high detection rate, great resistance and high lethality. The pneumonia caused by multiple drug-resistant Pseudomonas aeruginosa infection is hard to treat, with poor prognosis and high mortality, it has become one of the thorniest problems in the field of clinical medical anti infection, which needs to be solved urgently. One of the core pathogenic mechanism of Pseudomonas aeruginosa is that lipopolysaccharide activates TLR4 signal pathway and triggers inflammatory cascade reaction as ＂waterfall effect＂,which can lead to sepsis and even septic shock. Pneumonia belongs to the wind warm and pulmonary heat disease in TCM. Deficiency of vital qi, toxicity-blood stasis syndrome is throughout this disease. The prescription of Fuzheng Jiedu Huayu which came from a long period of clinical practice from the research group of fever in our hospital, is fit to the syndrome mentioned above and has significant effect in treating pneumonia caused by Pseudomonas aeruginosa. The mechanism may be related to inhibiting the inflammatory injury caused by Pseudomonas aeruginosa infection, promoting the recovery of inflammatory injury,delaying or inhibiting or even reversing the resistance of Pseudomonas aeruginosa,and synergistic bacteriostasis with antibiotics.

关 键 词：铜绿假单胞菌 肺炎 炎症瀑布效应 Toll样受体4 扶正解毒化瘀方 

分 类 号：R256.1[医药卫生—中医内科学]