参附联合维生素C对脓毒性休克患者血管内皮损伤的保护作用研究

王世伟; 吕丹; 龚好; 陈丽; 徐欣晖; 熊剑飞

doi:10.13201/j.issn.1009-5918.2021.10.001

参附联合维生素C对脓毒性休克患者血管内皮损伤的保护作用研究

- 上海交通大学医学院附属仁济医院急诊科(上海, 200120)
基金项目:
上海市综合医院中西医结合专项(No:ZHYY-ZXYJHZX-201902)

国家自然科学基金面上项目(No:81971803,81671881)

详细信息

通讯作者: 熊剑飞,E-mail:jianfei_xiong@sina.com

中图分类号: R459.7；R631.2

收稿日期: 2021-08-12

Protective effects of Shenfu injection and vitamin C on vascular endothelial injury in patients with septic shock

- Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200120, China

More Information

Corresponding author: XIONG Jianfei, E-mail: jianfei_xiong@sina.com

Received Date: 12 August 2021

摘要

摘要: 目的:探究脓毒性休克患者联合应用参附和维生素C后血管内皮损伤指标的变化。方法:选择2020年8月-2021年7月期间符合纳入及排除标准的40例脓毒性休克患者,根据不同的治疗方案,随机分入常规治疗组、联合治疗组。两组患者均接受脓毒症标准化治疗,在此基础上,联合治疗组在脓毒症标准治疗外联合参附和维生素C治疗。对比两组患者治疗前及治疗后(第1、3、5天)的APACHE-Ⅱ评分、SOFA评分、血浆炎症因子及血管内皮损伤指标(Angiopoietin-2、Syndecan-1)水平。同时,统计两组患者的住院天数、病死率、总费用等数据以评估疗效。结果:两组患者的APACHE-Ⅱ评分和SOFA评分在治疗后第1天、第3天、第5天均下降(P<0.05);组间比较发现,联合治疗组的APACHE-Ⅱ和SOFA评分显著低于常规治疗组,联合治疗组的平均住院天数和血管活性药物使用时间显著低于常规治疗组(P<0.05)。联合治疗组的血清CRP、PCT、IL-6、Angiopoietin-2、Syndecan-1水平在治疗后第1天、第3天、第5天显著低于常规治疗组(P<0.05)。结论:在脓毒性休克患者中,参附和维生素C联合常规治疗方案能够显著减轻血管内皮损伤和炎症反应,从而获得更佳的治疗效果,这可能是一种有前景的治疗方案。
- 脓毒性休克 /
- 参附注射液 /
- 维生素C /
- 血管内皮损伤
Abstract: Objective:To investigate the effects of Shenfu injection(SFI) and vitamin C on vascular endothelial injury in patients with septic shock.Methods:A total of 40 patients with septic shock who met the inclusion and exclusion criteria were enrolled from August 2020 to July 2021. They were randomly divided into conventional treatment group and combined treatment group according to various treatment plans. The patients in the conventional treatment group received standard treatment for sepsis shock, while patients in the combined treatment group received standard treatment combined with SFI and vitamin C. The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores, sepsis-related organ failure assessment(SOFA) scores and the levels of inflammatory factors, angiopoietin-2(Ang-2), and syndecan-1 in serum were compared before and after treatment(days 1, 3, and 5) between the two groups. Meanwhile, other data such as hospital stay and mortality of the two groups were collected to evaluate the curative effect.Results:APACHE Ⅱ scores and SOFA scores of patients in both groups decreased at 1, 3 and 5 days after treatment(P<0.05).Compared with the conventional treatment group, APACHE Ⅱ and SOFA scores of the combined treatment group improved more(P<0.05). The average hospital stay and the duration of using vasoactive drugs in the combined treatment group were significantly lower than those in the conventional treatment group(P<0.05). Compared with the conventional treatment group, the serum levels of CRP, PCT, IL-6 and Ang-2 in the combined group decreased significantly at 1, 3 and 5 days after treatment, while syndecan-1 increased at 1, 3 and 5 days after treatment, with statistical significance(P <0.05).Conclusion:SFI and vitamin C combined with conventional treatment can reduce vascular endothelial injury and inflammatory in patients with septic shock, and achieve a better therapeutic effect, which could be a promising treatment method.
- septic shock /
- Shenfu injection /
- vitamin C /
- vascular endothelial injury

HTML全文

参考文献(28)

[1]	Joffre J,Hellman J,Ince C,et al.Endothelial Responses in Sepsis[J].Am J Respir Crit Care Med,2020,202(3):361-370.
[2]	Rhodes A,Evans LE,Alhazzani W,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016[J].Crit Care Med,2017,45(3):486-552.
[3]	Zhang XM,Guo T,Zhang KC,et al.Effect of shenfu injection on microcirculation in shock patients:A protocol for systematic review and meta-analysis[J].Medicine(Baltimore),2020,99(43):e22872.
[4]	Zaric B,Obradovic M,Trpkovic A,et al.Endothelial Dysfunction in Dyslipidaemia:Molecular Mechanisms and Clinical Implications[J].Curr Med Chem,2020,27(7):1021-1040.
[5]	Gaudette S,Hughes D,Boller M.The endothelial glycocalyx:Structure and function in health and critical illness[J].J Vet Emerg Crit Care(San Antonio),2020,30(2):117-134.
[6]	Inkinen N,Pettilä V,Lakkisto P,et al.Association of endothelial and glycocalyx injury biomarkers with fluid administration,development of acute kidney injury,and 90-day mortality:data from the FINNAKI observational study[J].Ann Intensive Care,2019,9(1):103.
[7]	Anand D,Ray S,Srivastava LM,et al.Evolution of serum hyaluronan and syndecan levels in prognosis of sepsis patients[J].Clin Biochem,2016,49(10-11):768-776.
[8]	Parikh SM.Angiopoietins and Tie2 in vascular inflammation[J].Curr Opin Hematol,2017,24(5):432-438.
[9]	Akwii RG,Sajib MS,Zahra FT,et al.Role of Angiopoietin-2 in Vascular Physiology and Pathophysiology[J].Cells,2019,8(5):471.
[10]	Tian R,Wang XL,Pan TT,et al.Plasma PTX3,MCP1 and Ang2 are early biomarkers to evaluate the severity of sepsis and septic shock[J].Scand J Immunol,2019,90(6):e12823.
[11]	Pierce RW,Shabanova V,Canarie M,et al.Angiopoietin Level Trajectories in Toddlers with Severe Sepsis and Septic Shock and Their Effect on Capillary Endothelium[J].Shock,2019,51(3):298-305.
[12]	Fang YY,Li CS,Shao R,et al.The role of biomarkers of endothelial activation in predicting morbidity and mortality in patients with severe sepsis and septic shock in intensive care:A prospective observational study[J].Thromb Res,2018,171:149-154.
[13]	中国医疗保健国际交流促进会急诊医学分会,中华医学会急诊医学分会,中国医师协会急诊医师分会,等.中国脓毒症早期预防与阻断急诊专家共识[J].临床急诊杂志,2020,21(7):517-529.
[14]	Li Y,Zhang XY,Lin PH,et al.Effects of Shenfu Injection in the Treatment of Septic Shock Patients:A Multicenter,Controlled,Randomized,Open-Label Trial[J].Evid Based Complement Alternat Med,2016,2016:2565169.
[15]	Ince C,Mayeux PR,Nguyen T,et al.The endothelium in sepsis[J].Shock,2016,45(3):259-270.
[16]	Pons S,Arnaud M,Loiselle M,et al.Immune Consequences of Endothelial Cells' Activation and Dysfunction During Sepsis[J].Crit Care Clin,2020,36(2):401-413.
[17]	Hahn RG,Patel V,Dull RO.Human glycocalyx shedding:Systematic review and critical appraisal[J].Acta Anaesthesiol Scand,2021,65(5):590-606.
[18]	王志飞,田大力,张雯,等.参附注射液药品风险控制研究思路及实践[J].中国中药杂志,2014,39(18):3641-3644.
[19]	Li MQ,Pan CG,Wang XM,et al.Effect of the Shenfu Injection Combined with Early Goal-Directed Therapy on Organ Functions and Outcomes of Septic Shock Patients[J].Cell Biochem Biophys,2015,72(3):807-812.
[20]	Fan KL,Wang JH,Kong L,et al.Effect of Shen-Fu Injection on Hemodynamics in Early Volume Resuscitation Treated Septic Shock Patients[J].Chin J Integr Med,2019,25(1):59-63.
[21]	Zhu JQ,Kang LY,Ye QF,et al.Effects of Shenfu Injection and Its Main Components on the Contraction of Isolated Rat Thoracic Aortic Rings[J].PLoS One,2013,8(10):e78026.
[22]	Huang P,Guo YH,Feng S,et al.Efficacy and safety of Shenfu injection for septic shock:A systematic review and meta-analysis of randomized controlled trials[J].Am J Emerg Med,2019,37(12):2197-2204.
[23]	Mou ZJ,Lv ZT,Li Y,et al.Clinical Effect of Shenfu Injection in Patients with Septic Shock:A Meta-Analysis and Systematic Review[J].Evid Based Complement Alternat Med,2015,2015:863149.
[24]	May JM,Harrison FE.Role of Vitamin C in the Function of the Vascular Endothelium[J].Antioxid Redox Signal,2013,19(17):2068-2083.
[25]	Scholz SS,Borgstedt R,Ebeling N,et al.Mortality in septic patients treated with vitamin C:a systematic meta-analysis[J].Crit Care,2021,25:17.
[26]	Wei XB,Wang ZH,Liao XL,et al.Efficacy of vitamin C in patients with sepsis:An updated meta-analysis[J].Eur J Pharmacol,2020,868:172889.
[27]	Ning L,Rong JB,Zhang ZC,et al.Therapeutic approaches targeting renin-angiotensin system in sepsis and its complications[J].Pharmacol Res,2021,167:105409.
[28]	Yang QL,Wijerathne H,Langston JC,et al.Emerging Approaches to Understanding Microvascular Endothelial Heterogeneity:A Roadmap for Developing Anti-Inflammatory Therapeutics[J].Int J Mol Sci,2021,22(15):7770.