大承气汤对多脏器功能不全综合征急性期蛋白水平影响的临床与实验研究

目的 :观察 3 2例多脏器功能不全综合征 (MODS)患者及MODS模型大鼠外周血急性期蛋白 (APP)水平及通里攻下治疗对其影响 ,同时观察体外经大肠杆菌内毒素活化的大鼠肝细胞分泌APP水平及大承气汤对大鼠肝细胞合成分泌APP的影响。方法 :抗原抗体反应比浊法测定上述标本中C反应蛋白 (CRP)、α1 酸性糖蛋白 (α1 AGP)、α1 蛋白酶抑制剂 (α1 AT)、α2 巨球蛋白 (α2 MG)、铜蓝蛋白 (Cp)、触珠蛋白 (Hp)、及转铁蛋白 (Tf)水平。 结果 :MODS患者血清APP水平较对照组显著升高 (P <0 0 1 ) ,经大承气汤行通里攻下治疗 3日后血清APP水平显著降低 (P <0 0 5 ) ;急性感染性腹膜炎及肠系膜动脉缺血再灌注所致MODS大鼠血清APP水平均显著高于对照组 (P <0 0 1 ) ,予大承气汤灌胃治疗 3日后血清APP水平降低 (P <0 0 5 ) ;体外培养大鼠肝细胞经LPS刺激活化后分泌APP水平升高 ,经与不同浓度含大承气汤有效吸收成分兔血清共育后 ,APP的分泌水平下降 ,各APP均呈剂量相关抑制作用。结论 :通里攻下法能降低致损因子对肝脏的刺激作用 ,抑制过度炎症反应对组织脏器的损害。

Clinical and Experimental Study of Effect on Acute Phase Protein Level of Multiple Organ Dysfunction Syndrome Treated with Dachengqi Decoction

OBJECTIVE: To investigate the level of acute phase protein level (APP) synthesized in hepatocytes in pathogenic process of multiple organ dysfunction syndrome (MODS) and the effect of Dachengqi Decoction (DCQD) on it. METHODS: The levels of C-reactive protein (CRP), alpha 1-acid glycoprotein (alpha 1-AGP), alpha 1-antitrypsin total (alpha 1-AT), alpha 2-macroglobulin (alpha 2-MG), ceruloplasmine (Cp), hepatoglobin (Hp) and transferrin (Tf) synthesis were determined in 32 cases of MODS patients and rat models of MODS induced by acute infective peritonitis and mesenterial artery ischemia-reperfusion. RESULTS: The serum APP level in MODS patients was increased and higher than that in the control group (P < 0.01). After 3 days of DCQD treatment, it reduced significantly (P < 0.05). Serum APP level in MODS model was also increased significantly, and after 3 days of DCQD treatment, it reduced significantly (P < 0.05). The APP secreting level of rat hepatocytes cultured in vitro raised after stimulated and activated by lipopolysacchride, which was reduced after cultured with rabbits' serum containing different concentration of effective ingredients of DCQD. The APP inhibiting effect of DCQD was dose dependent. CONCLUSIONS: Purgation therapy with DCQD could reduce the stimulation of pathogenic factors on hepatocytes, protect the tissues and organs from injury caused by excessive inflammatory reaction.