Therapeutic effect of Qingre Tongfu Huayu Formula combined with blood purification on acute pancreatitis
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摘要: 目的 探讨清热通腑化瘀方结合血液净化治疗急性胰腺炎患者的疗效，及对肠道微生态、胃电图参数及血清巨噬细胞炎性蛋白-1α(macrophage inflammatory protein-1α，MIP-1α)、钙黏蛋白E(E-cadherin)的影响。方法 选择2020年5月-2022年5月收治的148例急性胰腺炎患者为研究对象，按照随机数字表法分为观察组和对照组，每组各74例。对照组接受常规西医治疗以及血液净化，观察组在对照组基础上接受清热通腑化瘀方治疗。比较两种治疗方式的疗效、中医证候积分、肠道微生态、胃电图参数及对患者血清MIP-1α、E-cadherin水平的影响。结果 观察组患者治疗后的有效率高于对照组(91.89% vs 79.73%)，差异有统计学意义(P < 0.05)。观察组患者的症状(腹痛、腹胀、肠鸣音)以及实验室指标(血常规、血淀粉酶、尿淀粉酶)改善时间均短于对照组，差异有统计学意义(P < 0.05)。治疗后两组患者的中医证候(恶心呕吐、上腹疼痛、黄疸、发热、脉细或滑数、舌红苔白薄)积分均明显降低，其中观察组患者治疗后的积分均低于对照组，差异有统计学意义(P < 0.05)。两组患者治疗后的D-乳酸、血淀粉酶、二胺氧化酶以及肠杆菌、肠球菌水平均降低，而双歧杆菌、乳杆菌水平均增加，其中观察组的改善程度优于对照组，差异有统计学意义(P < 0.05)。两组患者治疗后的胃电图平均频率、主频率以及振幅均有增加趋势，其中观察组治疗后胃电参数高于对照组，差异有统计学意义(P < 0.05)。两组患者治疗后血清MIP-1α、E-cadherin水平均明显降低，其中观察组患者治疗后血清MIP-1α、E-cadherin水平低于对照组，差异有统计学意义(P < 0.05)。结论 清热通腑化瘀方结合血液净化治疗急性胰腺炎效果较好，可加快患者的症状恢复，改善胃肠道生理状态以及肠道微生态，降低血清MIP-1α、E-cadherin水平，且安全性较好，值得临床推广。Abstract: Objective To investigate the efficacy of Qingre Tongfu Huayu Formula combined with blood purification in the treatment of acute pancreatitis, and its effects on intestinal microecology, gastric electroparameters, serum macrophage inflammatory protein-1α(MIP-1α) and E-cadherin.Methods One hundred and forty-eight patients with acute pancreatitis admitted from May 2020 to May 2022 were selected and divided into the observation group and the control group according to random number table method, with 74 cases in each group. The control group received conventional Western medicine treatment and blood purification, and the observation group received Qingre Tongfu Huayu Formula on the basis of the control group. The efficacy, Traditional Chinese Medicine syndrome score, intestinal microecology, electrogastrogram parameters and their effects on serum MIP-1α and E-cadherin were compared between the two treatments.Results The effective rate of the observation group was higher than that of the control group(91.89% vs 79.73%), the difference was statistically significant(P < 0.05). The improvement time of symptoms(abdominal pain, abdominal distension, intestinal sound) and laboratory indicators(blood image, blood amylase, urine amylase) in the observation group was shorter than that in the control group(P < 0.05). After treatment, the scores of the main syndroms(nausea and vomiting, epigastric pain, jaundice, fever, thin or smooth pulse, red tongue, and thin tongue) of the two groups were significantly decreased, and the scores of the observation group were lower than those of the control group(P < 0.05). After treatment, the levels of D-lactic acid, blood amylase, Enterobacterium, and Enterococcus were decreased in two groups, while the levels of bifidobacterium and Lactobacillus were increased, and the improvement degree of the observation group was better than the control group(P < 0.05). After treatment, FP, FZ and AP in the two groups showed an increasing trend, and the gastric electrical parameters in the observation group were higher than those in the control group(P < 0.05). Serum MIP-1α and E-cadherin in two groups were significantly decreased after treatment, and the levels of MIP-1α and E-cadherin in observation group were lower than those in the control group(P < 0.05).Conclusion Qingre Tongfu Huayu Formula combined with blood purification has a good effect in the treatment of acute pancreatitis, which can accelerate the recovery of symptoms, improve gastrointestinal physiological state and intestinal microecology, reduce the serum level of MIP-1α and E-cadherin, and has good safety, worthy of clinical promotion.
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表 1 两组患者的临床资料比较
例，X±S 组别 例数 性别 年龄/岁 病程/h APACHEⅡ评分/分 男 女 观察组 74 42 32 55.32±4.05 10.31±2.52 22.31±2.42 对照组 74 46 28 54.13±4.83 9.67±2.36 21.88±2.25 t/χ2 0.448 1.624 1.595 1.119 P 0.503 0.107 0.113 0.265 
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表 2 两组患者的临床疗效比较
例 组别 例数 痊愈 显效 有效 无效 总有效率/% 观察组 74 30 26 12 6 91.89 对照组 74 17 25 17 15 79.73 χ2 4.495 P 0.034
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表 3 两组患者的临床症状以及实验室指标改善时间比较
d，X±S 组别 例数 腹痛 腹胀 肠鸣音 血常规 血淀粉酶 尿淀粉酶 观察组 74 4.68±0.85 7.04±1.12 4.42±0.77 12.95±1.55 6.35±0.89 8.05±1.13 对照组 74 3.81±0.78 5.12±0.94 3.14±0.54 10.69±1.42 5.21±0.78 6.46±0.83 t 6.487 11.296 11.708 9.248 8.287 9.755 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 4 两组患者的中医证候积分比较
分，X±S 组别 例数 恶心呕吐 上腹疼痛 黄疸 发热 脉细或滑数 舌红苔白薄 观察组 74 治疗前 4.33±0.97 4.21±0.93 4.03±0.88 4.26±0.92 4.02±0.86 4.04±0.97 治疗14 d后 0.88±0.181)2) 0.78±0.141)2) 0.73±0.151)2) 0.81±0.181)2) 0.79±0.171)2) 0.77±0.181)2) 对照组 74 治疗前 4.38±0.78 4.16±0.96 4.12±0.85 4.21±0.86 4.08±0.91 3.98±0.85 治疗14 d后 1.42±0.241) 1.25±0.231) 1.12±0.201) 1.22±0.241) 1.28±0.251) 1.19±0.211) 与本组治疗前比较，1)P < 0.05；与对照组治疗14 d后比较，2)P < 0.05。
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表 5 两组患者的肠道微生态比较
X±S 组别 例数 D-乳酸/(ng/L) 血淀粉酶/(U/L) DAO/(IU/mL) 双歧杆菌 肠杆菌 乳杆菌 肠球菌 观察组 74 治疗前 12.12±1.15 1 134.33±357.85 7.03±1.38 3.26±0.53 10.46±1.67 40.04±2.97 6.57±0.96 治疗14 d后 7.14±0.961)2) 450.73±80.781)2) 4.46±0.751)2) 6.74±0.791)2) 7.31±1.171)2) 45.78±3.451)2) 4.47±0.641)2) 对照组 74 治疗前 12.02±1.28 1 164.38±320.78 7.12±1.25 3.37±0.48 10.57±1.61 39.68±2.87 6.48±1.21 治疗14 d后 8.57±1.371) 651.57±120.681) 5.64±0.981) 5.22±0.731) 8.79±1.251) 42.78±3.751) 5.36±0.731) 与本组治疗前比较，1)P < 0.05；与对照组治疗14 d后比较，2)P < 0.05。
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表 6 两组患者的胃电参数比较
X±S 组别 例数 FP/CPM FZ/CPM AP/μV 治疗前 治疗14 d后 治疗前 治疗14 d后 治疗前 治疗14 d后 观察组 74 2.12±0.28 3.84±0.341) 2.32±0.48 3.75±0.521) 92.75±20.28 213.84±40.341) 对照组 74 2.16±0.25 3.31±0.311) 2.27±0.41 3.26±0.621) 94.16±18.25 173.31±34.311) t 0.917 9.909 0.681 5.209 0.445 6.584 P 0.361 < 0.001 0.497 < 0.001 0.657 < 0.001 与本组治疗前比较，1)P < 0.05。
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表 7 两组患者的血清MIP-1α、E-cadherin水平比较
pg/mL，X±S 组别 例数 MIP-1α E-cadherin 治疗前 治疗14 d后 治疗前 治疗14 d后 观察组 74 642.02±116.32 249.37±35.821) 846.25±143.95 346.34±65.221) 对照组 74 638.49±122.68 368.49±46.791) 820.72±134.15 454.73±74.841) t 0.688 17.390 1.116 9.393 P 0.492 ＜0.001 0.226 ＜0.001 与本组治疗前比较，1)P < 0.05。
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[1] Beyer G, Hoffmeister A, Lorenz P, et al. Clinical practice guideline, acute and chronic pancreatitis[J]. Dtsch Arztebl Int, 2022, 119(29-30): 495-501.
[2] 郭丹妮, 冯淑兰, 董明国. 电针配合大承气汤灌肠辅治重症急性胰腺炎胃肠功能障碍的临床观察[J]. 中国中西医结合消化杂志, 2022, 30(4): 275-279. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=9d411e78-6414-4428-a671-c5080bafd557
[3] 明志祥, 许健华, 张若怡. 加味清胰汤治疗急性胰腺炎的临床疗效分析[J]. 中国中西医结合消化杂志, 2021, 29(4): 284-287. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=a4393044-4b4b-40f8-b604-228a9b86fc6b
[4] 宋冰, 汪永锋, 张延英, 等. 中医辨证诊治急性胰腺炎方法研究[J]. 中华中医药学刊, 2020, 38(2): 88-91. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202002024.htm
[5] 李君秋, 曹红燕, 肖铁刚, 等. 大承气汤治疗急性胰腺炎患者胃肠功能障碍的临床观察[J]. 中国中西医结合消化杂志, 2021, 29(10): 686-690. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=4d886de2-9f81-4b3f-ac14-3d379612216a
[6] 杨丹, 魏莉莉, 孙银凤, 等. 中药灌肠联合西医常规疗法治疗重症急性胰腺炎临床疗效的Meta分析[J]. 中国中西医结合急救杂志, 2022, 29(2): 177-182.
[7] 焦巨英, 刘建均, 娄妮, 等. 中药调节急性胰腺炎肠道菌群紊乱[J]. 中华中医药学刊, 2020, 38(7): 135-138.
[8] Garrido VT, Banerjee S. E-cadherin: an Enigma in pancreatic diseases[J]. Cell Mol Gastroenterol Hepatol, 2020, 9(1): 191-192. doi: 10.1016/j.jcmgh.2019.10.004
[9] 郭喆, 关键. 重症急性胰腺炎预防与阻断急诊专家共识[J]. 临床急诊杂志, 2022, 23(7): 451-462. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202207001.htm
[10] Wu XM, Ji KQ, Wang HY, et al. MIP-1α induces inflammatory responses by upregulating chemokine receptor 1/chemokine receptor 5 and activating c-Jun N-terminal kinase and mitogen-activated protein kinase signaling pathways in acute pancreatitis[J]. J Cell Biochem, 2019, 120(3): 2994-3000. doi: 10.1002/jcb.27049
[11] 王卫伟, 王忠玉. 腹腔镜联合胆道镜治疗急性胆源性胰腺炎伴胆囊结石疗效及对患者血清巨噬细胞炎性蛋白-1α、巨噬细胞炎性蛋白-1β和单核细胞趋化因子蛋白-1水平的影响[J]. 陕西医学杂志, 2021, 50(9): 1114-1118. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYZ202109018.htm
[12] 中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南(2019年, 沈阳)[J]. 中华消化杂志, 2019, 39(11): 721-730. https://xuewen.cnki.net/CCND-SYRB202307160030.html
[13] 张声生, 李乾构, 李慧臻, 等. 急性胰腺炎中医诊疗专家共识意见[J]. 中华中医药杂志, 2013, 28(6): 1826-1831. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201709066.htm
[14] 郑筱萸. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 233-236.
[15] Szatmary P, Grammatikopoulos T, Cai WH, et al. Acute pancreatitis: diagnosis and treatment[J]. Drugs, 2022, 82(12): 1251-1276.
[16] 钱家鸣, 吴东. 筚路蓝缕40年: 我国急性胰腺炎的基础和临床研究[J]. 中华消化杂志, 2021, 41(8): 505-508. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202201017.htm
[17] 张继燃, 徐继扬. 急性胰腺炎肠黏膜上皮细胞凋亡及相关治疗的研究[J]. 临床急诊杂志, 2017, 18(7): 557-559. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC201707025.htm
[18] 申鼎成, 黄耿文. 危重型急性胰腺炎的研究进展[J]. 中国普通外科杂志, 2022, 31(9): 1129-1134. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ202209001.htm
[19] Gliem N, Ammer-Herrmenau C, Ellenrieder V, et al. Management of severe acute pancreatitis: an update[J]. Digestion, 2021, 102(4): 503-507.
[20] Iannuzzi JP, King JA, Leong JH, et al. Global incidence of acute pancreatitis is increasing over time: a systematic review and meta-analysis[J]. Gastroenterology, 2022, 162(1): 122-134.
[21] 刘凤斌, 胡玲, 陈苏宁, 等. 消化系统常见病急性胰腺炎中医诊疗指南(基层医生版)[J]. 中华中医药杂志, 2020, 35(4): 1906-1913. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202004079.htm
[22] 王天麟, 冯彬彬, 韩俊泉, 等. 浅析"透热转气"及清营汤在重症急性胰腺炎继发脓毒症中的应用[J]. 中国中西医结合消化杂志, 2022, 30(12): 859-862, 866. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=8d7dddec-13ed-4c55-87d5-ca77fdcb8ebc
[23] 谢彩杏, 陈国忠, 陈小霞, 等. 基于国家专利数据库分析中药复方治疗急性胰腺炎用药规律[J]. 国际中医中药杂志, 2022, 44(7): 796-800.
[24] Li XY, He C, Zhu Y, et al. Role of gut microbiota on intestinal barrier function in acute pancreatitis[J]. World J Gastroenterol, 2020, 26(18): 2187-2193.
[25] Cienfuegos JA, Valenti V, Rotellar F. Acute pancreatitis: an opportunity for gastroenterology hospitalists?[J]. Rev Esp Enferm Dig, 2022, 114(2): 73-75.
[26] 宋曦, 徐奇, 何莲, 等. CPFA对重症急性胰腺炎患者炎性介质、肠黏膜屏障功能的影响[J]. 中国老年学杂志, 2022, 42(22): 5473-5475. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202222019.htm
[27] 王晶晶, 蔡常春, 张晴, 等. 联合使用大黄、芒硝对重症急性胰腺炎患者肠道功能和炎性因子的影响[J]. 中成药, 2019, 41(5): 1191-1193. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYA201905052.htm
[28] 张辉, 施仲义, 胡一迪, 等. 自拟通腑泻热汤联合中药保留灌肠法治疗重症急性胰腺炎的临床观察[J]. 中国中医急症, 2019, 28(2): 337-339. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ201902044.htm
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