大承气汤对急危重症患者急性肠功能障碍的影响及TLR/MyD88/NF-κB-p65信号通路调控机制研究  

Effects of Dachengqi Decoction for Critically Ill Patients with Acute Intestinal Dysfunction and the Regulation Mechanism of TLR/MyD88/NF-κB-p65 Signaling Pathway

作　　者：季永欣 庄明东 吴昌安[1] 柳冬兵 刘芸芸[1] Ji Yongxin;Zhuang Mingdong;Wu Chang′an(Huzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Zhejiang,Huzhou 313000,China)

机构地区：[1]浙江中医药大学附属湖州市中医院

出　　处：《中国中医急症》2019年第12期2156-2159,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：浙江省湖州市科技局公益性应用研究项目(2017GY46)

摘　　要：目的观察大承气汤对急危重症患者急性肠功能障碍的影响并探讨其对Toll样受体(TLR)/髓样分化因子88(MyD88)/核因子-κB-p65(NF-κB-p65)信号通路调控机制。方法 108例患者随机分为观察组与对照组各54例。对照组予以西医标准化方案治疗,观察组在对照组基础上加用大承气汤治疗。比较两组临床疗效及胃肠功能改善情况,治疗前后测定外周血中TLR/MyD88/NF-κB-p65信号通路相关因子水平,并与54例健康体检者(健康组)进行比较。结果观察组首次排便时间、首次排气时间、肠鸣音恢复时间、住院时间均短于对照组(P <0.05);观察组的28 d多系统器官功能衰竭(MSOF)发生率显著低于对照组(P <0.05),但两组28 d死亡率比较差异无统计学意义(P> 0.05)。治疗第3、7、14日,观察组血清Toll样受体2(TLR2)、Toll样受体4(TLR4)、MyD88、NF-κB-p65、p-NF-κB-p65及其下游炎症细胞因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平均显著低于对照组(P <0.05),但两组治疗前后各指标水平均显著高于健康组(P <0.05)。结论大承气汤可有效防治急危重症患者急性肠功能障碍并改善临床预后,其机制可能与调节TLR/MyD88/NF-κB-p65信号通路过度激活及其下游炎症因子有关。Objective:To investigate the effects of Dachengqi Decoction on critically ill patients with acute intestinal dysfunction and the regulation mechanism of TLR/MyD88/NF-κB-p65 signaling pathway. Methods:108 patients were randomly divided into the observation group and the control group,54 cases in each. The control group was treated with Western medicine standardization program,the observation group treated with Dachengqi Decoction on that basis. The clinical efficacy and improvement of gastrointestinal function were compared between the two groups. The serum levels of TLR/MyD88/NF-κB-p65 signaling pathway related factors were measured before and after treatment,and compared with 54 healthy subjects(the healthy group). Results:The first defecation time,the first exhaust time,the recovery time of bowel sounds and the hospitalization time in the observation group were significantly shorter than those of the control group(P < 0.05). The incidence of MSOF on 28 th day in the observation group was significantly lower than that in the control group(P < 0.05),while there was no significant difference in mortality between the two groups on 28 th day(P > 0.05). On the 3 rd,7 th and 14 th days after treatment,serum levels of TLR2,TLR4,MyD88,NF-κB-p65,p-NF-κB-p65,its downstream inflammatory cytokines IL-1β,IL-6 and IL-8 and TNF-α in the observation group were significantly lower than those in the control group(P <0.05). However,the levels of the indicators above before and after treatment were significantly higher than those in the healthy group(P < 0.05). Conclusion:Dachengqi Decoction can effectively treat the acute intestinal dysfunction in critically ill patients and improve clinical prognosis. Its mechanism may be related to the regulation of TLR/MyD88/NF-κB-p65 signaling pathway over-activation and its downstream inflammatory factors.

关 键 词：急危重症 急性肠功能障碍 大承气汤 Toll样受体 髓样分化因子88 核因子-κB 

分 类 号：R574[医药卫生—消化系统]