大黄对脓毒症患者血管内皮细胞功能的保护作用  

Protective effect of Rhubarb on vascular endothelial cell function in sepsis patients

作　　者：何龙平 窦建林 钟林翠 林青伟 余甜 宋景春 He Long-Ping;Dou Jian-Lin;Zhong Lin-Cui;Lin Qing-Wei;Yu Tian;Song Jing-Chun(Graduate School of Jiangxi University of Chinese Medicine,Nanchang,Jiangxi 330004,China;Intensive Care Unit/Nanchang City’s Key Laboratory of Thrombosis and Hemostasis,the 908th Hospital of Chinese PLA Logistical Support Force,Nanchang,Jiangxi 330002,China)

机构地区：[1]江西中医药大学研究生院,江西南昌330004 [2]解放军联勤保障部队第908医院重症医学科/南昌市血栓止血学重点实验室,江西南昌330002

出　　处：《解放军医学杂志》2022年第10期1013-1019,共7页Medical Journal of Chinese People's Liberation Army

基　　金：江西省卫健委科技计划(SKJP220210977)。

摘　　要：目的 探讨大黄对脓毒症患者血管内皮细胞功能的保护作用。方法 采用前瞻性单中心随机对照研究,选取2020年7月-2021年9月解放军联勤保障部队第908医院重症医学科收治的脓毒症患者41例,随机分为大黄治疗组(n=20)与对照组(n=21)。大黄治疗组采取基础治疗联合大黄治疗,对照组采取基础治疗联合生理盐水灌胃。分别于给药前、给药24 h、给药72 h采血,检测常规凝血项目[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原、凝血酶时间(TT)、纤维蛋白原降解产物(FDP)、D-二聚体、抗凝血酶Ⅲ(AT-Ⅲ)、血小板计数、血小板分布宽度]及凝血分子标志物[血栓调节蛋白(TM)、组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂-1复合物(t-PAIC)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α抗纤溶酶复合物(PIC)],比较两组不同给药时间的相关指标,并采用生存分析比较两组的预后情况。结果 大黄治疗组给药72 h的纤维蛋白原水平[(3.5±1.0) g/L]明显高于对照组72 h的纤维蛋白原水平[(2.7±0.8) g/L],较大黄治疗组给药前的纤维蛋白原水平[(2.7±0.9) g/L]也明显升高,差异有统计学意义(P<0.05)。与对照组给药前的TM[19.0(15.5,22.6) TU/ml]、t-PAIC[15.4(9.7,20.9) ng/ml]相比,对照组72 h的TM[27.3(20.8,31.2) TU/ml]、t-PAIC[22.2(15.5,38.6) ng/ml]明显升高,差异有统计学意义(P<0.05);与对照组72 h的TM、t-PAIC[分别为27.3(20.8,31.2) TU/ml,22.2(15.5,38.6) ng/ml]相比,大黄治疗组72 h的TM[13.2(10.9,18.0) TU/ml]、t-PAIC[9.2(7.3,23.1) ng/ml]明显降低,差异有统计学意义(P<0.05);大黄治疗组72 h的TM水平较大黄治疗组给药前[19.7(17.1,23.4) TU/ml]、大黄治疗组24 h[18.6(15.3,21.1) TU/ml]明显降低,差异有统计学意义(P<0.05)。生存分析结果显示,两组14 d生存率差异无统计学意义(P>0.05)。结论 大黄能够下调脓毒症患者的TM及t-PAIC水平,并改善脓毒症患者的血管内皮细胞功能�Objective To evaluate the protective effect of Rhubarb on vascular endothelial cell function in the sepsis patients.Methods We carried out a prospective,single-center,randomized controlled study based on 41 patients with sepsis who admitted to the Intensive Care Unit of the 908th Hospital of PLA.The patients were randomly divided into (Rhubarb) treatment group (n=20) and control group (n=21).Blood samples were collected before,24 h and 72 h after the medication.Conventional coagulation tests[prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen,thrombin time (TT),fibrin degradation products (FDP),D-dimer,antithrombin (AT-Ⅲ),platelet count,platelet distribution width]and coagulation molecular markers including thrombomodulin (TM),tissue plasminogen activator-inhibitor complex (t-PAIC),thrombin-antithrombin complex (TAT),plasmin-αantiplasmin complex (PIC) were detected and statistically analyzed.Results The fibrinogen level[(3.5±1.0) g/L]at the 72 h after administration in (Rhubarb) treatment group was significantly higher than that in control group[(2.7±0.8) g/L]and (Rhubarb) treatment group before administration[(2.7±0.9) g/L](P<0.05).Compared with the serum TM[19.0(15.5,22.6) TU/ml]and t-PAIC[15.4(9.7,20.9) ng/ml]levels before treatment in control group,the TM[27.3(20.8,31.2) TU/ml]and t-PAIC[22.2 (15.5,38.6) ng/ml]at the 72 h after administration in control group significantly increased (P<0.05).Compared with TM[27.3(20.8,31.2) TU/ml]and t-PAIC[22.2(15.5,38.6) ng/ml]of control group,the TM[13.2(10.9,18.0) TU/ml]and t-PAIC[9.2(7.3,23.1) ng/ml]at the 72 h after administration in (Rhubarb) treatment group were significantly decreased (P<0.05).Compared with the serum TM[19.7(17.1,23.4) TU/ml]levels before treatment and the TM[18.6(15.3,21.1) TU/ml]at the 24 h after administration in (Rhubarb) treatment group,the TM at the 72 h after administration were significantly decreased (P<0.05).Kaplan-Meier analysis revealed that there was no statistically significant difference in 14-day surviv

关 键 词：脓毒症 大黄属 凝血分子标志物 内皮细胞 

分 类 号：R631[医药卫生—外科学]