化痰通腑方通过TGF-β1/Smad3信号通路对脓毒症肺损伤患者抗炎反应及预后的作用机制  

Mechanism of Huatan Tongfu Prescription on Anti-lnflammatory Reactions and Prognosis in Patients with Sepsis-Associated Lung Injury Through TGF-β1/Smad3 Signaling Pathway

作　　者：宋琳琳 齐红松 孔玲玲 SONG Linlin;QI Hongsong;KONG Lingling(Emergency Department,The First Affliated Hospital of Henan University,Kaifeng Henan 475000,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Henan University,Kaifeng Henan 475000,China;Department of Emergency and Intensive Care Medicine,The First Affiliated Hospital of Henan University,Kaifeng Henan)

机构地区：[1]河南大学第一附属医院急诊科,河南开封475000 [2]河南大学第一附属医院呼吸与危重症医学科,河南开封475000 [3]河南大学第一附属医院急诊重症医学科,河南开封475000

出　　处：《新中医》2024年第6期73-79,共7页New Chinese Medicine

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220648)。

摘　　要：目的:研究化痰通腑方通过TGF-β1/Smad3信号通路对脓毒症肺损伤患者抗炎反应及预后的作用机制。方法:本次前瞻性研究的研究对象为80例脓毒症肺损伤患者,研究时间为2019年3月至2022年12月,将研究对象按随机数字表法分为2组各40例。对照组采用基础治疗,研究组在对照组基础治疗上服用化痰通腑方。连续治疗5 d。比较2组疗效情况、入住重症监护室(ICU)时间、机械通气时间,以及根据1个月随访结果记录28 d病死率,比较2组治疗前后脓毒症症状评分、氧合指数(PaO_(2)/FiO_(2))、肺泡动脉氧分压差[Pa(A-a)O_(2)],以及肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、转化生长因子-β1(TGF-β1)含量和Smad3蛋白表达水平。结果:治疗结束后,2组脓毒症症状评分(恶心呕吐评分除外)均低于治疗前(P<0.05),研究组脓毒症症状评分均低于对照组(P<0.05);研究组入住ICU时间和机械通气时间均低于对照组(P<0.05),为期1个月的随访结果显示,2组均无28 d病死病例;研究组治疗总有效率92.50%高于对照组75.00%(P<0.05);治疗结束后,2组PaO_(2)/FiO_(2)均高于治疗前(P<0.05),研究组PaO_(2)/FiO_(2)高于对照组(P<0.05);治疗结束后,2组Pa(A-a)O2均低于治疗前(P<0.05),研究组Pa(A-a)O_(2)低于对照组(P<0.05);治疗结束后,2组血清TNF-α、IL-6、IL-8含量均低于治疗前(P<0.05),研究组血清TNF-α、IL-6、IL-8含量均低于对照组(P<0.05);治疗结束后,2组血清TGF-β1含量和Smad3蛋白表达水平均低于治疗前(P<0.05),研究组血清TGF-β1含量和Smad3蛋白表达水平均低于对照组(P<0.05)。结论:化痰通腑方治疗脓毒症肺损伤疗效良好,可改善机体炎症水平和提高预后,其作用机制可能与抑制TGF-β1/Smad3信号通路的表达有关。Objective:To study the mechanism of Huatan Tongfu Prescription on anti-inflammatory reactions and prognosis in patients with sepsis-associated lung injury through TGF-β1/Smad3 signaling pathway.Methods:A total of 80 patients with sepsis-associated lung injury were included into this prospective study,from March 2019 to December 2022.The study subjects were divided into two groups according to the random number table method,with 40 cases in each group.The control group received basic treatment,and the study group was treated with Huatan Tongfu Prescription based on basic treatment.Both groups were treated for 5 days.The 28-day mortality rates based on 1-month follow-up results,the curative effects,Intensive Care Unit(icU)hospitalization,and mechanical ventilation time were compared between the two groups.The sepsis symptom scores,oxygenation index(PaO_(2)/FiO_(2)),alveolar-arterial oxygen gradient[Pa(A-a)O_(2)],and levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),transforming growth factor-β1(TGF-β1)content and Smad3 expression were compared before and after treatment between the two groups.Results:After treatment,the sepsis symptom scores(Nausea and vomiting symptom scores were excluded)in the two groups were lower than those before treatment(P<0.05),and the sepsis symptom score in the study group was lower than that in the control group(P<0.05).The ICU hospitalization and mechanical ventilation time in the study group were lower than those in the control group(P<0.05).The 1-month follow-up results showed that there was no 28-day mortality case in the two groups.The total effective rate was 92.50%in the study group,higher than that of 75.00%in the control group(P<0.05).After treatment,the PaO_(2)/FiO_(2)in the two groups was higher than that before treatment(P<0.05),and the PaO_(2)/FiO_(2)in the study group was higher than that in the control group(P<0.05).After treatment,the Pa(A-a)O_(2)in the two groups was lower than that before treatment(P<0.05),and the Pa(A-a)O_(2)level i

关 键 词：脓毒症 急性肺损伤 化痰通腑方 TGF-β1/Smad3信号通路 抗炎反应 

分 类 号：R631.2[医药卫生—外科学]