清胰汤对SAP合并感染患者单核细胞HLA-DR表达的影响

摘要

目的：探讨清胰汤对重症急性胰腺炎（SAP）并发感染患者单核细胞HLA-DR表达的影响。方法33例SAP合并感染患者随机分成3组：SAP并发感染组（Ⅱ组）、GM-CSF治疗组（Ⅲ组）、清胰汤治疗组（Ⅳ组）；选取7例SAP未并发感染患者为对照组（Ⅰ组）；各组均予常规治疗，Ⅲ、Ⅳ组在常规治疗基础上加用GM-CSF或清胰汤治疗，一周后检测外周血WBC，血淀粉酶，ET，CRP，IL-6以及单核细胞HLA-DR表达率。结果Ⅱ、Ⅲ、Ⅳ组患者在各项血清学指标均高于Ⅰ组，单核细胞HLA-DR表达水平低于Ⅰ组（P<0.05）；而Ⅲ、Ⅳ组患者各项指标较Ⅱ组明显改善（P<0.05）。结论 SAP并发感染患者存在单核细胞免疫功能缺陷，而清胰汤治疗能够改善这种免疫功能障碍以及过度炎症反应。%Objective To investigate the effect of Qingyi decoction on HLA-DR expression of the monocytes in the infectious patients with severe acute pancreatitis(SAP). Method 33 infectious patients with SAP were randomly divided into three groups:SAP complicated by infection group(Ⅱ),SAP complicated by infection treated by GM-CSF(Ⅲ),SAP complicated by infection treated by Qingyi decoction(Ⅳ). Besides,7 SAP patients without infection were recruited to control group(Ⅰ). All patients received routine comprehensive treatment after hospitalization,while groupⅢand groupⅣpatients additionally received GM-CSF or Qingyi decoction as an adjutant therapy. All groups were treated for 7 days. The peripheral blood WBC,amylase,ET,IL-6,CRP were detected,and HLA-DR expression of monocytes were detected. Result The HLA-DR expression level of groupⅡ,groupⅢand groupⅣpatients were lower than groupⅠ(P<0.05),and the every serum index in them were higher than groupⅠ(P<0.05). Compared with the patients in groupⅡ,the every serum index and the HLA-DR expression level of patients in groupⅢand groupⅣwere ameliorated(P<0.05). Conclusion Monocyte anergy is present in patients with severe acute pancreatitis,and SAP patients with infection are more severe. Furthermore,the treatment of Qingyi decoction can ameliorate monocytes-mediated immune function of SAP patients with infection and soften excessive inflammatory response.