世界中医药

目的:探究炎调方对脓毒症急性肾损伤(AKI)疗效及对T辅助细胞22(Th22)和Th17细胞水平影响性。方法:选取2016年10月至2018年10月上海中医药大学附属曙光医院收治的脓毒症合并AKI患者98例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组49例。对照组予控制感染、维持电解质平衡等西医治疗,观察组在西医治疗基础上加用炎调方治疗,均治疗7 d。观察治疗前后2组肾功能、炎性反应因子、免疫功能、Th22细胞、Th17细胞变化并比较疗效。结果:1)完成治疗后2组肌酐(SCr)、尿素氮(BUN)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞(WBC)、降钙素原(PCT)较治疗前均显著下降(P<0.05),完成治疗后观察组以上指标均显著低于对照组(P<0.05)。2)完成治疗后2组尿神经轴突导向因子(Netrin-1)、尿IL-18、尿肾损伤分子-1(KIM-1)、尿中心粒细胞明胶酶相关脂质运载蛋白(NGAL)较治疗前均显著下降(P<0.05),完成治疗后观察组以上指标均显著低于对照组(P<0.05)。3)完成治疗后2组Th22、Th17、IL-17、IL-22较治疗前均显著下降(P<0.05),完成治疗后观察组以上指标均显著低于对照组(P<0.05)。4)完成治疗后2组IgG、IgA、IgM、CD4+、CD8+较治疗前均显著升高(P<0.05),完成治疗后观察组以上指标均显著高于对照组(P<0.05)。5)完成治疗后观察组临床痊愈率、总有效率显著高于对照组,比较差异有统计学意义(P<0.05)。结论:炎调方能抑制脓毒症AKI患者TNF-α、IL-6、及Th22/Th17等炎性反应细胞水平,减轻脓毒症全身炎性反应,从而具有保护肾功能、提高免疫的作用。

English Summary:

To explore the effect of Tiaoyan Formula on acute kidney injury(AKI)in sepsis and its influence on the levels of Th22 and Th17 cells.Methods:A total of 98 AKI patients admitted to Shuguang Hospital，Shanghai University of Traditional Chinese Medicine，from October 2016 to October 2018 were selected as the research objects and were randomly divided into a control group(49 cases)and a observation group(49 cases)according to the order of visiting.The control group received infection control and electrolyte balance maintenance，while the observation group received Tiaoyan Decoction on the basis of the control group for 7 days.The changes of inflammatory factors，renal function，immune function，Th22 cells and Th17 cells before and after treatment were observed and compared.Results:1）After treatment，creatinine(SCr)，urea nitrogen(BUN)，tumor necrosis factor-alpha(TNF-alpha)，interleukin-6(IL-6)，white blood cell(WBC)，procalcitonin(PCT)in the 2 groups were significantly lower than those before treatment(P<0.05)，and the above indexes in the observation group were significantly lower than those in the control group(P<0.05). 2)After treatment，the levels of Netrin-1，IL-18，KIM-1 and NGAL in urine of the 2 groups were significantly lower than those before treatment(P<0.05)，and the above indexes in the observation group were significantly lower than those in the control group(P<0.05). 3)After treatment，Th22，Th17，IL-17 and IL-22 in the 2 groups were significantly lower than those before treatment(P<0.05)，and the above indexes in the observation group were significantly lower than those in the control group(P<0.05). 4)IgG，IgA，IgM，CD4+，CD8+ in the 2 groups were significantly higher than those before treatment(P<0.05)，and the above indexes in the observation group were significantly higher than those in the control group(P<0.05). 5)After treatment，the clinical recovery rate and total effective rate of the observation group were significantly higher than those of the control group，and the difference was statistically significant(P<0.05).Conclusion:Tiaoyan Formula can inhibit Th22/Th17 cells and other inflammatory reactions in AKI patients，reduce the systemic inflammatory response of sepsis，protect renal function and improve immunity，so as to improve the curative effect.

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