钟勇 杨芳智 郭文曦

摘要  目的：觀察参附注射液治疗脓毒症急性肝损伤的患者的临床疗效及肝脏排泄功能，同时检测相关指标变化分析其保护作用机制。方法：选取2017年6月至2019年2月永川区中医院收治的脓毒症合并急性肝损伤患者65例作为研究对象，采用随机数字表法随机分为对照组（ n =33）与观察组（ n =32），2组患者均常规西医基础治疗，观察组则加以参附注射液静脉滴注治疗，分别在治疗前和治疗2周后，对患者的临床疗效、肝功能、炎性因子、抗氧化应激因子进行检测，观察分析其变化。结果：1）治疗后对照组治疗总有效率为71.42%，观察组治疗总有效率为93.33%。2）2组患者的肝功能各项指标均较治疗前明显降低（ P <0.05），且观察组优于对照组（ P <0.05）。3）患者的促炎性因子血清IL-1、IL-10、TNF-α水平均较治疗前明显降低（ P <0.05），且观察组优于对照组（ P <0.05）;而抑炎性因子Sirtl的表达情况与之相反（ P <0.05）。4）2组患者的肝脏组织内NRF2表达均上调，血清HO-1、CAT水平明显下降（ P <0.05），且观察组优于对照组（ P <0.05）。结论：结合参附注射液治疗脓毒症急性肝损伤可以有效提高临床疗效，促进肝脏代谢，降低促炎因子的表达，上调抑炎因子的表达，从而改善肝脏损害，这可能与其激发患者体内抗氧化应激和炎性反应机制有关。

关键词  参附注射液;脓毒症;急性肝损伤;肝功能;肝脏排泄;炎性反应因子;抗氧化应激;疗效

Effects of Shenfu Injections on Liver Excretion Function in Patients of Sepsis Complicated with Acute Liver Injury and Its Protective Mechanism

ZHONG Yong，YANG Fangzhi，GUO Wenxi

（Chongqing Yongchuan District Hospital of Traditional Chinese Medicine，Department of Critical Care Medicine，Chongqing 402160，China）

Abstract Objective： To observe the clinical efficacy of Shenfu injections in the treatment of sepsis complicated with acute liver injury and liver excretion function，at the same time，detect the changes of related indicators to analyze its protective mechanism. Methods： A total of 65 patients with sepsis complicated with acute liver injury treated in Chongqing Yongchuan District Hospital of Traditional Chinese Medicine from June 2017 to February 2019 were selected and randomly divided into control group（33 cases）and observation group（32 cases）by random number table method.Both groups were treated with basic Western medicine routinely.The observation group was treated with Shenfu injectionS intravenous drip.Before and after treatment，respectively，the clinical efficacy，liver function，inflammatory factors and antioxidant stress factors were tested，and the changes were observed and analyzed. Results： 1）After treatment，the total effective rate of the control group was 71.42%，and that of the observation group was 93.33%.2）The indexes of liver function in the two groups were significantly lower than those before treatment（ P <0.05），and the observation group was better than the control group（ P <0.05）.3）The levels of Pro-inflammatory factor：IL-1，IL-10 and TNF-αlpha in serum of the patients were significantly lower than those before treatment（ P <0.05），and the observation group was better than the control group（ P <0.05），while the expression of anti-inflammatory factor Sirtl was the opposite（ P <0.05）.4）The expression of NRF2 in liver tissue was up-regulated in both groups，and the levels of HO-1 and CAT in serum were significantly decreased（ P <0.05），and the observation group was better than the control group（ P <0.05）. Conclusion： Basic Western medicine combined with Shenfu injections can effectively improve the clinical efficacy，promote liver metabolism，reduce the expression of pro-inflammatory factors and up-regulate the expression of anti-inflammatory factors in sepsis patients with acute liver injury，which may be related to its stimulation of anti-oxidative stress and inflammatory reaction mechanism in patients.

Keywords  Shenfu injections; Sepsis; Acute liver injury; Liver function; Liver excretion; Inflammatory factors; Antioxidant stress; Curative effect

中图分类号：R256.4;R259 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.016

机体发生严重感染时发生全身性炎性反应称之为脓毒症，如若治疗不及时则将可能继发休克、多脏器衰竭等，严重威胁机体生命安全[1]。其中肝脏是脓毒症最易攻击的脏器之一，有研究显示[2]，早期肝脏组织结构及代谢功能受损是脓毒症患者死亡的独立危险因子，肝脏受损与其他并发症，如血液循环、肾脏或中枢神经异常比较更敏感，因此有效治疗脓毒症患者肝功能是有效干预病情的关键。中医并无脓毒症病名记载，以“炎性反应、发热”为主要临床表现，多数属于“伤寒、厥证、脱证”等范畴，邪实与毒瘀相互交织，最终导致正气亏虚、瘀毒滞纳，故“邪毒炽盛，正气已虚”是脓毒症的关键[3-4]。……