血必净注射液对脓毒性休克患者心功能的保护作用及机制探讨
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摘要
目的:观察血必净注射液对脓毒性休克患者心功能的保护作用,并初步探讨其机制。方法:选取2014年10月—2017年11月医院收治的320例脓毒性休克(SS)患者,按照随机数表将其分为观察组和对照组,其中对照组给予常规治疗,观察组在常规治疗的基础上给予血必净注射液静脉滴注治疗。对比治疗前后两组患者心功能指标:左室每搏做功指数(LVSWI)、左室收缩末容积指数(LVESI)、左室舒张末容积指数(LVEDI)、心排血指数(CI)、左室射血分数(LVEF);对比治疗前后血清白介素-6(IL-6)、IL-10、肿瘤坏死因子-α(TNF-α)水平;对比治疗前后外周血单个核细胞(PBMC)中Toll样受体4(TLR4)、核因子-κB(NF-κB) mRNA相对表达量。结果:治疗后两组LVSWI、LVEF、CI均显著高于治疗前(P <0. 05),且治疗后观察组上述指标均显著高于对照组(P <0. 05);治疗后两组LVESI、LVEDI均显著低于治疗前(P <0. 05),且治疗后观察组上述指标均显著低于对照组(P <0. 05);治疗后两组血清IL-6、IL-10、TNF-α水平均显著低于治疗前(P <0. 05),且治疗后观察组上述指标均显著低于对照组(P <0. 05);治疗后两组PBMC中TLR4、NF-κB mRNA相对表达量均显著低于治疗前(P <0. 05),且治疗后观察组上述指标均显著低于对照组(P <0. 05)。结论:血必净注射液可显著提高SS患者心脏射血功能、降低心脏前负荷,改善其心功能,并且能减轻炎症反应,可能与抑制TLR4/NF-κB信号通路有关。
Objective: To observe the protective effect of Xuebijing Injection on cardiac function in patients with septic shock and explore its mechanism. Methods: A total of 320 patients with septic shock( SS) admitted to the hospital from October 2014 to November 2017 were enrolled in the observation group and the control group according to the random number table. The control group was given conventional treatment and the observation group was given intravenous infusion of Xuebijing Injection on the basis of conventional treatment. The cardiac function indexes of the two groups before and after treatment: left ventricular stroke index( LVSWI),left ventricular end-systolic volume index( LVESI),left ventricular end-diastolic volume index( LVEDI),cardiac output index( CI) and left ventricular effusion fraction( LVEF) were compared. The levels of serum interleukin-6( IL-6),IL-10 and tumor necrosis factor-α( TNF-α) were compared before and after treatment. The relative expressions of toll-like receptor 4( TLR4) and nuclear factor-κB( NF-κB) mRNA in peripheral blood mononuclear cells( PBMC) before and after treatment were compared. Results: The levels of LVSWI,LVEF and CI of the two groups after treatment were significantly higher than those before treatment( P < 0. 05) and the above indexes of the observation group were significantly higher than those of the control group after treatment( P < 0. 05). The levels of LVESI and LVEDI of the two groups after treatment were significantly lower than those before treatment( P < 0. 05),and the above indexes of the observation group were significantly lower than those in the control group after treatment( P < 0. 05). The levels of serum IL-6,IL-10 and TNF-α in the two groups after treatment 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 after treatment( P < 0. 05). The relative expressions of TLR4 and NF-κB mRNA in PBMC of the two groups after treatment 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 after treatment( P < 0. 05). Conclusion: Xuebijing Injection can significantly improve cardiac ejection function,reduce cardiac preload,improve cardiac function and reduce inflammation,which may be related to inhibition of TLR4/NF-κB signaling pathway.
Objective: To observe the protective effect of Xuebijing Injection on cardiac function in patients with septic shock and explore its mechanism. Methods: A total of 320 patients with septic shock( SS) admitted to the hospital from October 2014 to November 2017 were enrolled in the observation group and the control group according to the random number table. The control group was given conventional treatment and the observation group was given intravenous infusion of Xuebijing Injection on the basis of conventional treatment. The cardiac function indexes of the two groups before and after treatment: left ventricular stroke index( LVSWI),left ventricular end-systolic volume index( LVESI),left ventricular end-diastolic volume index( LVEDI),cardiac output index( CI) and left ventricular effusion fraction( LVEF) were compared. The levels of serum interleukin-6( IL-6),IL-10 and tumor necrosis factor-α( TNF-α) were compared before and after treatment. The relative expressions of toll-like receptor 4( TLR4) and nuclear factor-κB( NF-κB) mRNA in peripheral blood mononuclear cells( PBMC) before and after treatment were compared. Results: The levels of LVSWI,LVEF and CI of the two groups after treatment were significantly higher than those before treatment( P < 0. 05) and the above indexes of the observation group were significantly higher than those of the control group after treatment( P < 0. 05). The levels of LVESI and LVEDI of the two groups after treatment were significantly lower than those before treatment( P < 0. 05),and the above indexes of the observation group were significantly lower than those in the control group after treatment( P < 0. 05). The levels of serum IL-6,IL-10 and TNF-α in the two groups after treatment 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 after treatment( P < 0. 05). The relative expressions of TLR4 and NF-κB mRNA in PBMC of the two groups after treatment 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 after treatment( P < 0. 05). Conclusion: Xuebijing Injection can significantly improve cardiac ejection function,reduce cardiac preload,improve cardiac function and reduce inflammation,which may be related to inhibition of TLR4/NF-κB signaling pathway.
引文
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[11]闫春江,周仙仕,叶烨.脓毒症中医辨证处方规律及临床疗效的文献研究[J].中国中医急症,2016,25(12):2241-2244.
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[13]王永贤,贾敏,高景峰,等.红花注射液改善大鼠心肌缺血再灌注氧化损伤的作用机制研究[J].临床心血管病杂志,2016,32(11):1149-1153.
[14]鲁卓林,沈秀,王浩,等.血必净注射液的功效安全性再评价[J].国际生物医学工程杂志,2017,40(4):251-254.
[15]马昭,刘钢,杨莉,等.中药复方多糖对不同MHC B-LβⅡ基因型鸡淋巴细胞中TLR4介导的My D88依赖性途径的影响[J].中国畜牧兽医,2018,45(3):754-762.
[16]Rameshrad M,Maleki-Dizaji N,Vaez H,et al. Lipopolysaccharide Induced Activation of Toll Like Receptor 4 in Isolated Rat Heart Suggests a Local Immune Response in Myocardium[J]. Iran J Immunol,2015,12(2):104-116.
[17]付慧.丹参川芎嗪注射液对脓毒症患儿外周血前白蛋白、降钙素原、肿瘤坏死因子-α及T细胞亚群的影响[J].中国临床医生杂志,2018,46(1):13-17.
[2]万林骏,廖庚进,万晓红,等.严重脓毒症和感染性休克患者早期复苏时器官功能障碍的回顾性分析[J].中华危重病急救医学,2016,28(5):418-422.
[3]高嘉良,陈光,何庆勇,等.治疗气滞血瘀证中成药组方规律分析[J].中国中药杂志,2017,42(1):187-191.
[4]于春梅,王丽.血必净注射液治疗化脓性扁桃体炎临床疗效及对血清炎性因子的影响[J].现代中西医结合杂志,2016,25(23):2590-2592.
[5]Tsaousi GG,Pitsis AA,Ioannidis GD,et al. Implementation of Euro SCORE II as an adjunct to APACHE II model and SOFA score,for refining the prognostic accuracy in cardiac surgical patients[J]. J CardiovascSurg(Torino),2015,56(6):919-927.
[6]高戈,冯喆,常志刚,等. 2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505.
[7]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].全科医学临床与教育,2015,54(4):401-426.
[8]Chebbo A,Tan S,Kassis C,et al. Maternal Sepsis and SepticShock[J]. Crit Care Clin,2016,32(1):119-135.
[9]赵秀娟,朱凤雪,杜安琪,等.严重脓毒症患者主要不良心脏事件的危险因素分析[J].中国医药,2016,11(2):192-195.
[10]王晓鹏,陈腾飞,罗丹,等.基于不同辨证体系的脓毒症休克中医病机探析[J].中国中医急症,2018,27(1):101-104.
[11]闫春江,周仙仕,叶烨.脓毒症中医辨证处方规律及临床疗效的文献研究[J].中国中医急症,2016,25(12):2241-2244.
[12]Akaberi M,Iranshahi M,Mehri S. Molecular Signaling Pathways Behind theBiological Effects of Salvia Species Diterpenes in Neuropharmacology and Cardiology[J]. Phytother Res,2016,30(6):878-893.
[13]王永贤,贾敏,高景峰,等.红花注射液改善大鼠心肌缺血再灌注氧化损伤的作用机制研究[J].临床心血管病杂志,2016,32(11):1149-1153.
[14]鲁卓林,沈秀,王浩,等.血必净注射液的功效安全性再评价[J].国际生物医学工程杂志,2017,40(4):251-254.
[15]马昭,刘钢,杨莉,等.中药复方多糖对不同MHC B-LβⅡ基因型鸡淋巴细胞中TLR4介导的My D88依赖性途径的影响[J].中国畜牧兽医,2018,45(3):754-762.
[16]Rameshrad M,Maleki-Dizaji N,Vaez H,et al. Lipopolysaccharide Induced Activation of Toll Like Receptor 4 in Isolated Rat Heart Suggests a Local Immune Response in Myocardium[J]. Iran J Immunol,2015,12(2):104-116.
[17]付慧.丹参川芎嗪注射液对脓毒症患儿外周血前白蛋白、降钙素原、肿瘤坏死因子-α及T细胞亚群的影响[J].中国临床医生杂志,2018,46(1):13-17.