加味大承气汤对脓毒症相关性ARDS患者TGF-β1、CTGF的影响  

Effect of modified Dachengqi decotion on TGF-β1 and CTGF in patients with sepsis related ARDS

作　　者：莫路姣 许冠华 陆晓玲[2] 来嘉伟 沈建军 俞林峰 金王燕 黄旭华 沈晓圆 MO Lujiao;XU Guanhua;LU Xiaoling(Department of Intensive Care Medicine,Wenzhou Medical University Affiliated Xiaoshan Hospital,Hangzhou 311200,China.)

机构地区：[1]温州医科大学附属萧山医院重症医学科,浙江杭州311200 [2]浙江医院呼吸内科

出　　处：《全科医学临床与教育》2021年第12期1080-1083,共4页Clinical Education of General Practice

基　　金：萧山区重大科技计划政策引导项目(2019302);浙江省医药卫生科技计划项目(2018KY204)。

摘　　要：目的探讨加味大承气汤对脓毒症相关性急性呼吸窘迫综合征(ARDS)患者转化生长因子-β1(TGF-β1)、结缔组织生长因子(CTGF)的影响。方法选择脓毒症相关性ARDS患者80例,根据随机数字表分为观察组和对照组,对照组予常规西医治疗,观察组在常规西医治疗的基础上,增用加味大承气汤灌肠7 d,比较两组治疗前、治疗1 d、4 d、7 d后血清及肺泡灌洗液(BALF)中TGF-β1、CTGF的表达水平,以及氧合指数、腹内压、机械通气时间,并比较两组患者的28 d临床疗效和死亡率差异。结果治疗4 d、7 d后,观察组患者血清、BALF中的TGF-β1、CTGF表达均低于对照组,差异均有统计学意义(t分别=4.70、3.87、13.76、22.18、11.46、14.87、8.66、16.39,P均<0.05),观察组患者的氧合指数高于对照组,腹内压低于对照组,差异均有统计学意义(t分别=-12.54、-10.93、2.76、1.27,P均<0.05)。治疗28 d后,观察组患者的机械通气时间短于对照组,好转率高于对照组,死亡率低于对照组(t=4.37,χ^(2)分别=7.04、6.28,P均<0.05)。结论加味大承气汤对脓毒症相关性ARDS患者TGF-β1、CTGF的表达具有明显抑制作用,降低了肺纤维化的可能,且可降低腹内压及死亡率,改善氧合指数及预后。Objective To investigate the effect of modified Dachengqi decotion on transforming growth factor-β1(TGF-β1)and connective tissue growth factor(CTGF)in patients with sepsis related acute respiratory distress syndrome(ARDS).Methods A total of 80 patients with sepsis related ARDS were divided into observation group and control group according to random number table.The control group was treated with conventional western medicine,and the obser-vation group was additionally treated with enema of modified Dachengqi decotion for 7 days on the basis of conventional western medicine treatment.The expression levels of TGF-β1 and CTGF in serum and BALF before treatment,1d,4d and 7d after treatment were compared between the two groups,oxygenation index,intra-abdominal pressure,mechanical venti-lation time,efficacy and mortality rate after 28 days were compared between the two groups.Results Four days and sev-en days after treatment,the expressions of TGFβ1 and CTGF in serum and BALF of the observation group were lower than control group(t=4.70,3.87,13.76,22.18,11.46,14.87,8.66,16.39,P<0.05).The oxygenation index of the observ-ation group was higher than control group,and intra-abdominal pressure was lower than control group,the differences were statistically significant(t=-12.54,-10.93,2.76,1.27,P<0.05).Twenty-eight days after treatment,the mechanical ventilation time in the observation group was shorter than the control group,the improvement rate was higher than the control group,and the mortality rate was lower than the control group,with statistically significant differ-ences(t=4.37,χ2=7.04,6.28,P<0.05).Conclusion Modified Dachengqi decotion can significantly inhibit the expression of TGF-β1/CTGF in patients with sepsis related ARDS,reduce the possibility of pulmo-nary fibrosis,reduce intra-abdominal pressure and mortality rate,improve oxygenation index and prognosis.

关 键 词：加味大承气汤 急性呼吸窘迫综合征 转化生长因子-Β1 结缔组织生长因子 

分 类 号：R278[医药卫生—中医学]