泻下通瘀汤治疗流行性出血热伴急性肾功能衰竭的疗效及对CRP、TNF-α、IL-6、NGAL、KIM-1表达的影响  

Efficacy of Xiexia Tongyu Decoction in Treatment of Epidemic Hemorrhagic Fever with Acute Renal Failure and Influence on Expression of CRP,TNF-α,IL-6,NGAL,and KIM-1

作　　者：许辰阳 李绪燕 王晓光 Xu Chenyang;Li Xuyan;Wang Xiaoguang(Guangzhou University of Chinese Medicine,Guangdong,Guangzhou 519046,China)

机构地区：[1]广州中医药大学,广东广州510006 [2]广州中医药大学祈福医院,广东广州511495

出　　处：《中国中医急症》2020年第11期1951-1954,1988,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：广东省中医药局科研课题(20151075);广东省中医药局科研项目(粤中医[2013]17号);广州市番禺区科工商信局项目(2015-Z03-54)。

摘　　要：目的探讨泻下通瘀汤治疗流行性出血热(EHF)伴急性肾功能衰竭(ARF)的临床疗效及对血清C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)及尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)表达的影响。方法选取EHF-ARF患者82例,随机分为对照组与观察组各41例。对照组接受常规治疗,观察组在对照组基础上加用泻下通瘀汤治疗。治疗前后测定肾功能相关指标[血肌酐(Scr)、尿素氮(BUN)、β2微球蛋白(β2-MG)]、肾损伤标志物[血清胱抑素C(Cysc)、视黄醇结合蛋白(RBP)、尿NGAL、尿KIM-1]、血清炎症因子(CRP、TNF-α、IL-6)水平,评价中医证候积分及急性生理与慢性健康评估系统(APACHEⅡ)评分,比较组间临床疗效。结果与对照组相比,观察组临床疗效、中医证候疗效总有效率更高(P<0.05)。与对照组相比,治疗后观察组的中医证候积分、APACHEⅡ评分均较低,且Scr、BUN、β2-MG、Cysc、RBP、CRP、TNF-α、IL-6、尿NGAL、尿KIM-1水平均较低,差异均有统计学意义(P<0.05)。结论泻下通瘀汤治疗EHF-ARF有助于促进病情控制、改善肾功能并提高临床疗效,可能与下调血清炎性因子CRP、TNF-α、IL-6及NGAL、KIM-1表达,发挥抗炎及保护肾组织功能作用有关。Objective:To explore the clinical efficacy of Xiexia Tongyu Decoction in the treatment of epidemic hemorrhagic fever(EHF)with acute renal failure(ARF)and its influence on expression of C-reactive protein(CRP),tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6),neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule 1(KIM-1).Methods:A total of 82 EHF-ARF patients were randomly divided into the control group and observation group,41 cases in each group.The control group received conventional treatment,and the observation group was treated with Xiexia Tongyu Decoction on the basis of the control group.The renal function-related indicators[serum creatinine(Scr),urea nitrogen(BUN),β2 microglobulin(β2-MG)],kidney injury markers[serum cystatin C(Cysc),retinol binding protein(RBP),urine NGAL,urine KIM-1],serum inflammatory factors(CRP,TNF-α,IL-6)levels were detected,the traditional Chinese medical syndrome scores and acute physiological and chronic health evaluationⅡ(APACHEⅡ)scores were evaluated before and after treatment,the clinical efficacy were compared between the two groups.Results:Compared with the control group,the total effective rate of disease efficacy and traditional Chinese medical syndrome efficacy of observation group were higher(P<0.05).Compared with the control group,the traditional Chinese medical syndrome score and APACHEⅡscore of the observation group were lower after treatment,and the levels of Scr,BUN,β2-MG,Cysc,RBP,CRP,TNF-α,IL-6,urine NGAL,urine KIM-1 were also lower;all differences were statistically significant(P<0.05).Conclusion:Xiexia Tongyu Decoction is conducive to promoting disease control for patients with EHF-ARF,improving renal function and clinical efficacy,which may be related to down-regulation of serum inflammatory factors such as CRP,TNF-a,IL-6 and kidney injury markers such as NGAL,KIM-1 expression to anti-inflammatory and renal function protection.

关 键 词：流行性出血热 急性肾功能衰竭 泻下通瘀汤 炎症因子 中性粒细胞明胶酶相关脂质运载蛋白 肾损伤分子1 

分 类 号：R373.32[医药卫生—病原生物学]