骨及软组织损伤时白细胞介素1β与白细胞介素6变化及清热活血消肿合剂的干预效应

背景:作者自制的清热活血消肿Ⅰ,Ⅱ合剂治疗骨折并软组织损伤取得了良好疗效,但其机制尚不明确。目的:观察清热活血消肿合剂对闭合性骨伤所致软组织损伤患者血清白细胞介素1β、白细胞介素6的影响。设计:随机对照观察。单位:解放军第四○一医院中医科病房。对象:选择2000-02/2002-02在解放军第四○一医院中医科住院的骨折早、中期合并软组织损伤患者88例,均自愿参加观察。按随机数字表法分为2组,清热活血消肿Ⅰ Ⅱ合剂组45例,清热活血消肿Ⅱ合剂组43例。清热活血消肿Ⅰ合剂为内服剂,Ⅱ合剂为外,洗剂。方法:①治疗骨伤:两组均给予钙尔奇D片及壮骨关节丸口服。②治疗软组织损伤:清热活血消肿Ⅰ Ⅱ合剂组口服自制清热活血消肿Ⅰ合剂,每付药水煎450mL,分装成3袋,150mL/袋,3次/d;外用清热活血消肿Ⅱ合剂,洗患部,每付药水煎600mL,分装4袋,150mL/袋,每次取4袋药加水2000mL加热,洗患处,2次/d,每次,洗20～30min(4袋药可连续,洗2d)。清热活血消肿Ⅱ合剂组仅外用清热活血消肿Ⅱ合剂,洗患部,具体用法与清热活血消肿Ⅰ Ⅱ合剂组相同。两组患者均以10d为1个疗程,共治疗2个疗程,分别于治疗前、1个疗程、2个疗程后应用酶联免疫吸附试剂盒检测患者血清白细胞介素1β、白细胞介素6含量并进行比较。主要观察指标:两组患者治疗前、治疗1,2个疗程后的血清白细胞介素1β、白细胞介素6含量。结果:清热活血消肿Ⅰ Ⅱ合剂组治疗2个疗程后白细胞介素1β和白细胞介素6水平均较治疗前、治疗1个疗程后显著降低(P<0.05～0.01),亦较同时间点清热活血消肿Ⅱ合剂组显著降低(P<0.05)。此外,清热活血消肿Ⅰ Ⅱ合剂组治疗1个疗程后白细胞介素1β和白细胞介素6水平亦较治疗前显著降低(P<0.05)。清热活血消肿Ⅱ合剂组治疗2个疗程后白细胞介素1β水平较治疗前显著降低(P<0.05),白细胞介素6水平较治疗前和1个疗程后显著降低(P<0.05)。结论:清热活血消肿Ⅰ,Ⅱ合剂通过抑制血清白细胞介素1β、白细胞介素6水平治疗骨折并软组织损伤,两药合用的治疗效果优于单独用药。

Interventional effect of Qingre Huoxue Xiaozhong composition on interleukin 1 beta and interleukin 6 levels following bone and soft tissue injury

BACKGROUND:Qingre Huoxue Xiaozhong composition Ⅰ and Ⅱ made by ourselves are effective in treating bone fracture complicated by soft tissue injury.However,its mechanism is still unclear.OBJECTIVE:To observe the effect of Qingre Huoxue Xiaozhong composition on the levels of intedeukin 1β(IL-1β) and interleukin 6(IL-6) in serum of patients with closed bone injury-induced soft tissue injury.DESIGN:Randomized controlled observation.SETTING:Wards of the Department of Traditional Chinese Medicine,the 401 Hospital of Chinese PLA.PARTICIPANTS: Eighty-eight inpatients with bone fracture at early and moderate stages accompanied by soft tissue injury were chosen as volunteers to be studied in the Department of Traditional Chinese Medicine,the 401 Hospital of Chinese PLA between February 2000 and February 2002.The involved inpatients were assigned into 2 groups according to the table of random digit:Oingre Huoxue Xiaozhong composition Ⅰ + Ⅱ group (n=45) and Qingre Huoxue Xiaozhong composition Ⅱ group (n=43).Oingre Huoxue Xiaozhong composition Ⅰ was for internal administration,and Qingre Huoxue Xiaozhong composition Ⅱ was for external fumigation.METHODS:①Treatment of bone injury:Both caltrate D pellets and pills for strengthening bone joints were used in two groups.②Treatment of soft tissue injury: In the Qingre Huoxue Xiaozhong composition Ⅰ+ Ⅱ group,Qingre Huoxue Xiaozhong composition Ⅰ was decocted.Each decoction was 450 mL,and was packed into 3 pouches, 150 mL/pouch,three times a day;Qingre Huoxue Xiaozhong composition Ⅱ was decocted.Each decoction was 600 mL,and was packedinto 4 Douches,150 mL/pouch.Four pouches of Qingre Huoxue Xiaozhong composition Ⅱ was diluted by 2 000 mL water,then heated and used for fume-washing, twice a day, 20 to 30 minutes once. Four pouches could be used for fume-washing for 2 days successively. In the Oingre Huoxue Xiaozhong compositionⅡgroup, only Oingre Huoxue Xiaozhong composition Ⅱ was used to fume-wash the lesioned region.The concrete method was the same as that in the Qingre Huoxue Xiaozhong composition Ⅰ+Ⅱ group.In each group, ten days were set as one course of treatment,and totally, there are 2 courses of treatment.IL-1β and IL-6 levels in serum of patients were detected by with ELISA kit before.one and two courses after treatment, and compared separately.MAIN OUTCOME MEASURES: Levels of IL-1β and IL-6 in serum of patients in two groups before, one and two courses after treatment.RESULTS: In the eingre Huoxue Xiaozhong composition Ⅰ+Ⅱ group,the level of IL-1β and IL-6 was respectively significantly lower after 2 courses of treatment as compared with the previous one and one course after treatment (P＜0.05-0.01), also at the same time point in compared with the Qingre Huoxue Xiaozhong composition Ⅱ group (P＜0.05).In addition, in the Oingre Huoxue Xiaozhong composition Ⅰ+Ⅱ group,the level of IL-1β and IL-6 was respectively significantly decreased after one course of treatment as compared with before treatment (P＜0.05). In the Oingre Huoxue Xiaozhong composition Ⅱ group,after 2 courses of treatment,the level of IL-1β was significantly decreased as compared with before treatment, and the level of IL-β was also significantly decreased as compared with before treatment and after one course of treatment (P＜0.05).CONCLUSION: Qingre Huoxue Xiaozhong composition Ⅰ+Ⅱ can be used to treat bone fracture accompanied by soft tissue injury by inhibiting the levels of IL-1β and IL-6. The effect of the combination of Oingre Huoxue Xiaozhong composition Ⅰ and Ⅱ is superior to that of each alone.