不同剂量黄芪对脓毒症患者免疫功能和血小板活化因子的干预研究

沈丽娟; 吴锡平; 关云艳; 孙月雯; 王倩

不同剂量黄芪对脓毒症患者免疫功能和血小板活化因子的干预研究

南京中医药大学无锡附属医院，江苏无锡 214071

计量
- 文章访问数: 708
- HTML全文浏览量: 8
- PDF下载量: 494
- 被引次数: 0
出版历程
- 刊出日期: 2019-03-10

Intervention of Different Doses of Huangqi on Immune Function and Platelet Activating Factor in Patients with Sepsis

摘要

摘要: 目的观察不同剂量黄芪对脓毒症患者免疫功能和血小板活化因子的干预作用，探讨黄芪改善脓毒症患者免疫状态的作用机制。方法选择南京中医药大学无锡附属医院重症医学科收治的脓毒症患者60例，随机分为常规治疗组（20例，常规西医治疗）、低剂量黄芪组(20例，在常规西医治疗基础上加用黄芪颗粒1.5 g，每日1次）、高剂量黄芪组（20例，在常规西医治疗基础上加用黄芪颗粒3.0 g，每日1次），5 d为1个疗程。比较3组患者治疗前后急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭（SOFA）评分、外周血淋巴细胞亚群、血小板活化因子（PAF）水平及28 d病死率。结果治疗后不同剂量黄芪组病人的总T细胞、T辅助淋巴细胞、CD4⁺/CD8⁺、B淋巴细胞回升(P<0.05~0.01)，而T抑制淋巴细胞、NK细胞下降(P<0.05~0.01)，疗效优于常规组（P<0.05），高剂量组变化较低剂量组差异更显著(P<0.05)。3组患者PAF水平在治疗后均有下降(P<0.05)，两黄芪组均优于常规组（P<0.05），高剂量组PAF较低剂量组下降更明显(P<0.05)。3组患者APACHEⅡ评分、SOFA评分较治疗前明显下降(P<0.05)，两黄芪组均优于常规组（P<0.05）。低剂量及高剂量组28 d死亡率较常规组低(P<0.05)，两中药组之间无差异（P>0.05）。结论黄芪颗粒剂能调节脓毒症患者免疫失衡，改善死亡率，并呈剂量依赖性，其作用机制可能是通过调节PAF来实现的。
- 脓毒症 /
- 黄芪 /
- 免疫功能 /
- 血小板活化因子 /
- 作用机制
Abstract: OBJECTIVE To observe the effects of different doses of Huangqi on immune function and platelet activating factor in patients with sepsis， and to explore the mechanism of Huangqi in improving immune status of sepsis patients. METHODS 60 patients with sepsis admitted to the Department of Severe Medicine， Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine were randomly divided into three groups: conventional treatment group (20 cases， conventional western medicine treatment)， small dose of Huangqi group (20 cases， 1.5 g of Huangqi granules added on the basis of conventional western medicine treatment， once a day)， medium dose of Huangqi group (20 cases， 3.0 g of Huangqi granules added on the basis of conventional western medicine treatment， once a day)， 5 d a course. The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score， sequential organ failure score (SOFA)， peripheral blood lymphocyte subsets， platelet activating factor (PAF) level and 28-day mortality of the three groups before and after treatment were compared. RESULTS The number of total T cells， T helper lymphocyte， CD4⁺/CD8⁺， and B lymphocyte increased after treatment in different doses of Huangqi group (P<0.05， P<0.01)， while T-suppressed lymphocyte and NK cell decreased (P<0.05， P<0.01)， the curative effect was better than that in conventional treatment group (P<0.05)， and the difference was more significant in middle dosage group than small dosage group (P<0.05). The levels of PAF in the three groups decreased after treatment with statistical significance (P<0.05)， while those in the Huangqi groups were better than those in the conventional group (P<0.05). The decrease of PAF in the middle dose group was more obvious than that in the small dose group， and the difference was statistically significant (P<0.05). The APACHE Ⅱ score and SOFA score of the three groups were significantly lower than those before treatment (P<0.05)， while the Huangqi groups were better than the conventional group (P<0.05). The 28-day mortality rate in the middle dose and small dose groups were lower than that in the conventional group， and the difference was significant (P<0.05) but there was no difference between the two groups (P>0.05). CONCLUSION Huangqi granules can improve immune system and mortality of sepsis patients in a dose-dependent manner. Its mechanism may be accomplished by regulating PAF.
- sepsis /
- Huangqi /
- immune function /
- platelet activating factor /
- functionary mechanism

HTML全文

参考文献(14)

[1]	RHODES A， EVANS LE， ALHAZZANI W， et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016[J]. Crit Care Med， 2017， 43(3): 304-377.
[2]	FLEISCHMANN C， SCHERAG A， ADHIKARI NK， et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations[J]. Am J Respir Crit Care Med， 2016， 193 (3): 259-272.
[3]	董丽华，吕娟，丁黎莉，等. 脓毒症免疫治疗的研究进展[J]. 中华危重病急救医学， 2017， 29(2): 184-187.
[4]	陈扬波，张庚，胡马洪，等. 黄芪注射液对脓毒症患者免疫功能的影响[J]. 中国中医急症， 2008， 17(12): 1699-1701.
[5]	GOTTS JE， MATTHAY MA. Sepsis: pathophysiology and clinical management[J]. BMJ， 2016， 353: 1585.
[6]	LU CX， QIU T， TONG HS， et al. Peripheral T-lymphocyte and natural killer cell population imbalance is associated with septic encephalopathy in patients with severe sepsis[J]. Exp Ther Med， 2016，11(3): 1077-1084.
[7]	TAKEI F， SECHER DS， MILSTEIN C， et al. Use of a monoclonal antibody specifically non-reactive with T cells to delineate lymphocyte subpopulations[J]. Immunology， 1981， 42(3): 371-378.
[8]	KALIA N， BARDHAN KD， REED MW， et al. Mechanisms of Helicobacter Pylori induced rat gastric mueosal microeireulatory disturbances in vivo[J]. Dig Dis Sei， 2000， 45(4): 763-772.
[9]	ARIANO F， BUSSOLATI B， MIGLIORI M， et al. Platelet-activating factor synthesis by neutrophils， monocytes， and endothelial cells is modulated by nitric oxide production[J]. Shock， 2003， 19(4): 339-344.
[10]	YOST CC， WEYRICH AS， ZIMMERMAN GA. The platelet activating factor (PAF) signaling cascade in systemic inflammatory responses[J]. Biochimie， 2010，92(6): 692-697.
[11]	程鹏雁，马渝，陶杨，等. 脓毒症患者入ICU时血浆血小板活化因子水平与病情严重程度的相关性分析[J]. 重庆医科大学学报， 2014， 39(7):1027-1031.
[12]	BASTIEN Y， TOLEDANO BJ， MEHIO N， et al. Detection of functional platelet-activating factor receptors on human tonsillar B lymphocytes[J]. J Immunol， 1999， 162 (9): 5498-5505.
[13]	欧阳雪宇. 血小板活化因子及其受体与淋巴细胞[J]. 国外医学:免疫学分册， 2002， 25(5): 240-244.
[14]	BENEDETTA B， FILIPPO M， ALESSANDRO C， et al. Platelet-activating factor synthesized by IL-12-stimulated polymorphonuclear neutrophils and NK cells mediates chemotaxis[J]. J Immunol， 1998， 161(3): 1493-1500.