冯强 吕凡芹

摘要  目的：探讨黄连解毒汤合五味消毒饮对急性感染性心內膜炎（AIE）患者炎性反应状态的影响。方法：选取2017年1月至2018年6月邯郸市中心医院收治的AIE患者68例作为研究对象，按照入院顺序随机分为对照组和观察组，每组34例。2组均给予敏感抗生素治疗，观察组同时给予黄连解毒汤合五味消毒饮治疗。1周为1个疗程，2组均连续治疗4个疗程后进行临床疗效的观察。治疗后统计2组患者临床疗效，检测并比较2组治疗前后主要及次要症状、体征改善情况及血清炎性反应递质水平变化，记录并比较2组患者不良反应发生情况。结果：治疗后观察组临床治疗有效率为94.12%，较对照组的73.53%显著升高，差异有统计学意义（ P <0.05）;与治疗前比较，治疗后2组临床症状较治疗前明显改善，且观察组改善效果优于对照组，差异有统计学意义（ P <0.05）;2组血清白细胞介素-6（IL-6）、血清超敏C反应蛋白（hs-CRP）、血清降钙素原（PCT）、红细胞沉降率（ESR）水平均降低，观察组低于对照组，差异有统计学意义（ P <0.05）。2组均未见严重不良反应发生。结论：黄连解毒汤合五味消毒饮可改善AIE患者临床症状，抑制机体炎性反应，且有良好的安全性，临床疗效显著优于常规西医治疗。

关键词  急性感染性心内膜炎;黄连解毒汤;五味消毒饮;炎性反应递质;疗效;中医中药;抗生素;不良反应

Treatment of Acute Infective Endocarditis with Huanglian Jiedu Decoction and Wuwei Xiaodu Drink

FENG Qiang1， LYU Fanqin2

（1 Department of Cardiology， Handan Central Hospital， Handan 056002， China; 2 Department of Internal Medicine， the Fifth Hospital of Daqing City of Heilingjiang Province， Daqing 163000， China）

Abstract Objective： To explore the effects of Huanglian Jiedu Decoction and Wuwei Xiaodu Drink on inflammatory state of patients with acute infective endocarditis（AIE）.  Methods： A total of 68 cases patients with AIE in Handan Central Hospital were selected as the study objects and were divided randomly into a control group（ n =34）and an observation group（ n =34）according to order of admission with 34 cases in each group. Patients in 2 group were treated with sensitive antibiotics， while the observation group was given Huanglian Jiedu Decoction and Wuwei Xiaodu Drink at the same time. With 1 week as 1 course， the therapeutic effects were observed in 2 groups after treating for 4 courses continuously. The clinical efficacy in 2 groups were counted after treatment， the main and secondary symptoms， signs improvement and serum inflammatory factors levels changes before and after treatment were detected and compared， and the adverse reactions in 2 groups were recorded and compared.  Results： The clinical total effective rate in observation group after treatment was 94.12%， which was higher than 73.53% in control group（χ2=5.314，  P =0.021）. Compared with those before treatment， after treatment， the clinical symptoms of the 2 groups were significantly improved compared with those before treatment， and the improvement effect of the observation group was better than that of the control group（ P <0.01）; the serum IL-6， hs-CRP， PCT， and ESR levels of the 2 groups were reduced， and the observation group was lower than the control group（ P <0.01）. No serious adverse reactions occurred in 2 group.  Conclusion： Huanglian Jiedu Decoction and Wuwei Xiaodu Drink can improve the clinical symptoms of patients with AIE， inhibit the body′s inflammatory response， with good safety. The therapeutic effects is better than conventional Western medicine treatment significantly.

Keywords  Acute infective endocarditis; Huanglian Jiedu Decoction; Wuwei Xiaodu Drink; Inflammatory factors; Therapeutic effects; Traditional Chinese medicine and Chinese medicines; Antibiotics; Adverse reactions

中圖分类号：R289.5;R541 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.024

感染性心内膜炎（Infective Endocarditis，IE）为临床较为严重的感染性疾病，患者心脏内膜表面受到微生物感染，大量微生物与组织炎性细胞、纤维素团块等结合成赘生物，急性感染性心内膜炎（Acute Infective Endocarditis，AIE）通常病程可达数周，其中最常受累的部位为心脏瓣膜[1-2]。AIE若未得到及时有效的治疗，长时间发展可形成迁徙性感染及心脏瓣膜损坏，影响患者心脏功能，对其生命健康安全造成威胁。目前西医以早期、足量、静脉注射抗生素进行治疗，但是由于过度使用致使多重耐药及多菌株耐药现象多发，影响AIE的治疗效果[3]。从中医学的角度分析，AIE属于“胸痹”“内伤发热”[4]，现代医学研究认为，益气活血及清热解毒类中药同样具有抗菌、抗病毒、解热、消炎、调节机体免疫功能等多重疗效[5]。……