CAJ | 학술논문

四君子汤对持续性炎症-免疫抑制分解代谢综合征脾虚证患者的肠道保护及免疫调节作用
사군자탕대지속성염증-면역억제분해대사종합정비허증환자적장도보호급면역조절작용
The clinical effects of Sijunzi decoction on gut barrier protection and immune regulation in patients with persistent inflammation -immunosuppression catabolism syndrome accompanied by spleen-qi deficiency

万方数据

中国中西医结合急救杂志中國中西醫結閤急救雜誌 중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年 5期 335-339 ,共5页

牛素平%陈炜%李国菁%臧学峰%赵磊%冯兴中

우소평%진위%리국정%장학봉%조뢰%풍흥중

四君子汤%持续性炎症-免疫抑制分解代谢综合征%脾虚证%肠道保护%免疫四君子湯%持續性炎癥-免疫抑製分解代謝綜閤徵%脾虛證%腸道保護%免疫
사군자탕%지속성염증-면역억제분해대사종합정%비허증%장도보호%면역
Sijunzi decoction%Persistent inflammation-immunosuppression catabolism syndrome%Spleen-qi deficiency type%Gastrointestinal tract%Immunity

目的：观察四君子汤对持续性炎症-免疫抑制分解代谢综合征（PICS）脾虚证患者肠道功能的保护及免疫调节作用。方法采用前瞻性研究方法，选择首都医科大学附属北京世纪坛医院重症医学科收治的46例PICS患者，按随机数字表法分为四君子汤组和对照组，每组23例。两组均给予常规综合治疗，四君子汤组在综合治疗基础上给予四君子汤100 mL加减鼻饲，对照组在综合治疗基础上给予等量温开水鼻饲，两组均治疗2周。观察治疗前后两组患者相关中医证候和胃肠道功能改善情况，并分析外周血淋巴细胞亚群总T细胞（CD3+）、T辅助/诱导细胞（CD3+/CD4+）、T抑制/细胞毒细胞（CD3+/CD8+）、CD4/CD8、总自然杀伤细胞（NK细胞，CD3-/CD16+CD56+）、NK样T细胞（CD3+/CD16+CD56+）、总B细胞（CD19+）、调节性T细胞亚群（CD4+/CD25+）、抑制性T细胞（CD8+/CD28-）、细胞毒T细胞（CD8+/CD28+）的变化。结果①两组患者治疗前急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、不同急性胃肠功能损伤（AGI）分级患者数、外周血淋巴细胞亚群中各淋巴细胞数比较差异均无统计学意义（均P＞0.05）。②治疗2周后，四君子汤组和对照组患者脾虚证候群的疗效比较差异无统计学意义（有效：11例比6例，无效：12例比17例，均P＞0.05）；四君子汤组治疗后改善AGI相关临床表现的疗效优于对照组（14例比7例，P＜0.05）。③对照组治疗后CD3+、CD3+/CD8+、CD8+/CD28-均较治疗前显著增加〔CD3+：（62.37±7.83）%比（54.08±11.65）%， CD3+/CD8+：（31.52±10.55）%比（23.94±9.22）%，CD8+/CD28-：（24.97±10.25）%比（16.78±10.55）%〕，CD19+显著减少〔（5.78±5.33）%比（9.73±8.02）%〕，差异有统计学意义（均P＜0.05）。四君子汤组治疗后CD3+、CD3+/CD4+、CD3+/CD8+、CD8+/CD28-、CD8+/CD28+较治疗前显著增加〔CD3+：（74.53±7.64）%比（52.98±10.05）%， CD3+/CD4+：（36.27±12.08）%比（30.00±8.60）%，CD3+/CD8+：（37.33±12.56）%比（22.88±9.97）%，CD8+/CD28-：（26.89±10.80）%比（17.01±9.48）%，CD8+/CD28+：（12.08±5.50）%比（8.47±4.29）%〕，总CD19+显著减少〔（4.60±4.28）%比（9.86±8.61）%，P＜0.05〕。四君子汤组治疗后CD3+含量较对照组增高更显著〔（8.29±9.28）%比（5.80±5.33）%〕，差异有统计学意义（P＜0.05）。结论应用四君子汤可以改善脾虚症PICS患者的证候及胃肠道症状，可能通过调节T、B细胞数量改善患者免疫水平，提高患者免疫力，其中细胞免疫作用可能更大。
목적：관찰사군자탕대지속성염증-면역억제분해대사종합정（PICS）비허증환자장도공능적보호급면역조절작용。방법채용전첨성연구방법，선택수도의과대학부속북경세기단의원중증의학과수치적46례PICS환자，안수궤수자표법분위사군자탕조화대조조，매조23례。량조균급여상규종합치료，사군자탕조재종합치료기출상급여사군자탕100 mL가감비사，대조조재종합치료기출상급여등량온개수비사，량조균치료2주。관찰치료전후량조환자상관중의증후화위장도공능개선정황，병분석외주혈림파세포아군총T세포（CD3+）、T보조/유도세포（CD3+/CD4+）、T억제/세포독세포（CD3+/CD8+）、CD4/CD8、총자연살상세포（NK세포，CD3-/CD16+CD56+）、NK양T세포（CD3+/CD16+CD56+）、총B세포（CD19+）、조절성T세포아군（CD4+/CD25+）、억제성T세포（CD8+/CD28-）、세포독T세포（CD8+/CD28+）적변화。결과①량조환자치료전급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분、불동급성위장공능손상（AGI）분급환자수、외주혈림파세포아군중각림파세포수비교차이균무통계학의의（균P＞0.05）。②치료2주후，사군자탕조화대조조환자비허증후군적료효비교차이무통계학의의（유효：11례비6례，무효：12례비17례，균P＞0.05）；사군자탕조치료후개선AGI상관림상표현적료효우우대조조（14례비7례，P＜0.05）。③대조조치료후CD3+、CD3+/CD8+、CD8+/CD28-균교치료전현저증가〔CD3+：（62.37±7.83）%비（54.08±11.65）%， CD3+/CD8+：（31.52±10.55）%비（23.94±9.22）%，CD8+/CD28-：（24.97±10.25）%비（16.78±10.55）%〕，CD19+현저감소〔（5.78±5.33）%비（9.73±8.02）%〕，차이유통계학의의（균P＜0.05）。사군자탕조치료후CD3+、CD3+/CD4+、CD3+/CD8+、CD8+/CD28-、CD8+/CD28+교치료전현저증가〔CD3+：（74.53±7.64）%비（52.98±10.05）%， CD3+/CD4+：（36.27±12.08）%비（30.00±8.60）%，CD3+/CD8+：（37.33±12.56）%비（22.88±9.97）%，CD8+/CD28-：（26.89±10.80）%비（17.01±9.48）%，CD8+/CD28+：（12.08±5.50）%비（8.47±4.29）%〕，총CD19+현저감소〔（4.60±4.28）%비（9.86±8.61）%，P＜0.05〕。사군자탕조치료후CD3+함량교대조조증고경현저〔（8.29±9.28）%비（5.80±5.33）%〕，차이유통계학의의（P＜0.05）。결론응용사군자탕가이개선비허증PICS환자적증후급위장도증상，가능통과조절T、B세포수량개선환자면역수평，제고환자면역력，기중세포면역작용가능경대。
ObjectiveTo observe the role of Sijunzi decoction on the gut barrier protection and immunity regulation in spleen-qi deficiency type patients with persistent inflammation-immunosuppression catabolism syndrome (PICS).Methods A prospective study was conducted, and according to random number table, 46 patients with PICS accompanied by spleen-qi deficiency admitted to Department of Critical Care Medicine of Beijing Shijitan Hospital of Capital Medical University were randomly divided into two groups: control group and Sijunzi decoction group(each 23 cases). Conventional therapy was given to both groups, and the patients in Sijunzi decoction group were additionally treated with modified Sijunzi decoction 100 mL by nasal feeding, while those in the control group were treated with an equal amount of warm boiled water by nasal feeding. The course of treatment was 2 weeks in both groups. The improvement in traditional Chinese medicine(TCM) syndrome and gastrointestinal function was observed in two groups before and after treatment. At the same time, the changes of lymphocyte subsets including total T cells(CD3+ cells),helper/inducer T cells(CD3+/CD4+T cells), suppressor/cytotoxic T cells(CD3+/CD8+ T cells), CD4/CD8, total natural killer cells(NK cell,CD3-/CD16+CD56+ cells),natural killer like T cells(NK T cell,CD3+/CD16+CD56+ T cells),total B cells(CD19+ cells),regulatory T cells(Treg T cells, CD4+/CD25+ T cells),suppressor T cells(CD8+/CD28- T cells) and cytotoxic T cells(CD8+/CD28+ T cells)were analyzed.Results① There were no differences in the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,acute gastrointestinal injury(AGI)grades and peripheral blood lymphocyte subsets between Sijunzi decoction group and control group before treatment( allP>0.05).② After 2 weeks of treatment, all the patients' clinical symptoms of spleen-qi deficiencywere improved, and there was no difference in effect between the Sijunzi decoction and control group(valid:11 cases vs. 6 cases, invalid:12 cases vs.17 cases, bothP>0.05) . In both groups, the patients' AGI condition was improved, but the improvement in treatment group was more significant than that in the control group(valid: 14 cases vs. 7 cases, P<0.05) .③ In the control group,the numbers of CD3+, CD3+/CD8+,CD8+/CD28- T cells after treatment were increased significantly〔CD3+:(62.37±7.83)% vs.(54.08±11.65)%, CD3+/CD8+:(31.52±10.55)% vs. (23.94±9.22)%, CD8+/CD28-:(24.97±10.25)% vs.(16.78±10.55)%〕 and CD19+ number was decreased obviously〔(5.78±5.33)% vs.(9.73±8.02)%〕 at the same time(allP<0.05). After treatment, in the Sijunzi decoction group, the numbers of CD3+,CD3+/CD4+, CD3+/CD8+, CD8+/CD28-, CD8+/CD28+ T cells were increased significantly compared with those before treatment〔CD3+:(74.53±7.64)% vs.(52.98±10.05)%, CD3+/CD4+:(36.27±12.08)% vs.(30.00±8.60)%, CD3+/CD8+:(37.33±12.56)% vs.(22.88±9.97)%, CD8+/CD28-:(26.89±10.80)% vs.(17.01±9.48)%, CD8+/CD28+:(12.08±5.50)% vs.(8.47±4.29)%〕, and total CD19+ number was decreased remarkably at the same time〔(4.60±4.28)% vs.(9.86±8.61)%,P<0.05〕. In the Sijunzi decoction group, after 2 weeks of treatment, the number of CD3+ T cells was increased more significantly than that in the control group〔(8.29±9.28)% vs.(5.80±5.33)%,P<0.05〕.ConclusionUsing Sijunzi decoction combined with conventional therapy can improve the clinical symptoms of patients with PICS accompanied by spleen-qi deficiency and gastrointestinal dysfunction, the mechanism is possibly via enhancing immunity by regulating the numbers of B and T lymphocytes, and maybe the cell-mediated immunity plays a more prominent role.