痰热清联合西医常规治疗成人社区获得性肺炎痰热壅肺证的临床疗效及GC-MS代谢组学研究

目的探讨痰热清注射液联合西医常规治疗成人社区获得性肺炎(Community acquired pneumonia,CAP)痰热壅肺证的临床疗效及血清代谢组学研究。方法选取2018年1月—12月期间在秦皇岛市第一医院呼吸与危重症医学科接受治疗的100例CAP痰热壅肺证患者作为研究对象,随机分为对照组和治疗组,每组各50例。同时将进行健康体检的志愿者30例,设为健康组。对照组予以常规西药治疗,治疗组在对照组基础上加用痰热清注射液,均治疗10 d。观察两组患者的临床疗效、临床症状改善情况、不良反应及血常规、血生化指标水平。采用基于GC-MS的代谢组学技术分析各组血清样本中差异性代谢产物。结果治疗1个疗程后,治疗组患者总有效率为94.0%(47/50),略高于对照组84.0%(42/50),但差异无统计学意义(P>0.05)。治疗组退热、咳嗽和肺部啰音临床症状消失时间明显少于对照组患者,差异有统计学意义(P<0.05)。另外,治疗组患者治疗后WBC较治疗前和对照组明显降低(P<0.05)。通过GC-MS分析,共鉴定出121种代谢产物。综合VIP>1.0、Fold Change>1.5、P<0.05条件筛选差异性代谢物,治疗组β-羟基丁酸、花生四烯酸、谷氨酰胺、胸腺嘧啶、尿苷、乳酸表达低于对照组,而甲硫氨酸和葡萄糖酸表达高于对照组(P<0.05)。经代谢通路富集分析,花生四烯酸代谢(PI=2.618)和甲硫氨酸代谢(PI=2.247)与痰热清治疗关系最密切。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论痰热清注射液联合西医常规治疗成人CAP痰热壅肺证疗效显著,并推测可能通过调节花生四烯酸和甲硫氨酸代谢途径减轻CAP患者的临床症状和炎症反应。

Clinical Efficacy and GC-MS Metabonomics Study of Tanreqing Combined with Conventional Western Medicine in the Treatment of Community-Acquired Pneumonia

Objective To explore the clinical efficacy and serum metabonomics of Tanreqing injection combined with conventional western medicine in the treatment of adult community acquired pneumonia(CAP).Methods A total of100 CAP patients who were treated in the Department of Respiratory and Critical Care Medicine of Qinhuangdao No.1 Hospital from January to December 2018 were selected as the research objects,and they were randomly divided into a control group and a treatment group,with 50 cases in each group.At the same time,30 volunteers who underwent physical examination were set as healthy group.The control group was treated with conventional western medicine,and the treatment group was treated with Tanreqing injection on the basis of the control group for 10 days.Observe the clinical efficacy,improvement of clinical symptoms,adverse reactions,blood routine,and blood biochemical index levels of the two groups of patients.GC-MS-based metabolomics technology was used to analyze the differential metabolites in serum samples of each group.Results After 1 course of treatment,the total effective rate of patients in the treatment group was 94.0%(47/50),slightly higher than that of the control group 84.0%(42/50),but the difference was not statistically significant(P>0.05).The disappearance of clinical symptoms of fever,cough,and lung rales in the treatment group was significantly shorter than that in the control group,and the difference was statistically significant(P<0.05).In addition,the WBC of patients in the treatment group was significantly lower than that before treatment and the control group(P<0.05).Through GC-MS analysis,a total of 121 metabolites were identified.Comprehensive VIP>1.0,Fold Change>1.5,P<0.05 conditions to screen differential metabolites,the expression ofβ-hydroxybutyric acid,arachidonic acid,glutamine,thymine,uridine,and lactic acid in the treatment group was lower than that in the control group.The expression of methionine and gluconic acid was higher than that of the control group(P<0.05).Through enrichment analysis of metabolic pathways,arachidonic acid metabolism(PI=2.618)and methionine metabolism(PI=2.247)are most closely related to Tanreqing treatment.There was no significant difference in the incidence of adverse reactions between the two groups of patients(P>0.05).Conclusion Tanreqing injection combined with routine medication could significantly improve the clinical symptoms and inflammation in CAP patient,which would be related with metabolic pathways of arachidonic acid and methionine.