Gong Bei-lei, Zhang Yong, Xu Qi-xia, Chen Yu-qing
Department of Respiratory Medicine, the First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Laboratory of the Clinical Basis of Respiratory System, Bengbu 233000, Anhui, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2010 Sep;22(9):543-6.
To investigate the role of nuclear factor-ΚB (NF-ΚB) in severe pneumonia and observe the effects of Xuebijing injection in its treatment.
Thirty hospitalized patients with severe pneumonia were divided into the routine therapy group (n=14) and Xuebijing therapy group (n=16) in whom with Xuebijing injection 100 ml was given once daily for 7 days besides routine therapies, according to the random numeral. The DNA binding activity of NF-ΚB in human monocytes was detected before and 3 days and 7 days after administration, the contents of tumor necrosis factor-α (TNF-α), procalcitonin (PCT) and C-reactive protein (CRP) were determined, and the changes in coagulatory and fibrinolytic parameters were assayed at the same time. Acute physiology and chronic health evaluationII (APACHEII) score was also recorded. Ten healthy volunteers served as the healthy control group.
The DNA binding activities of NF-ΚB, the contents of TNF-α, PCT, CRP, fibrinogen (Fib), D-dimer in hospitalized subjects with severe pneumonia were higher before treatment than those in healthy control group, while the prothrombin time (PT), thrombin time (TT) were significantly lower (P<0.05 or P<0.01). Compared with the routine therapy group, the DNA binding activity of NF-ΚB (grey level) at the 7 days (66.60±36.23 vs. 79.90±39.11) was notably decreased in Xuebijing therapy group; the levels of TNF-α (ng/L, 25.81±11.67 vs. 33.78±13.36), PCT (μg/L, 1.91±1.09 vs. 2.96±1.80), CRP (mg/L, 20.01±7.21 vs. 26.59±10.66), Fib (g/L, 4.02±1.26 vs. 5.09±1.43), D-dimer (mg/L, 0.24±0.06 vs. 0.31±0.11) were significantly lower in Xuebijing therapy group, and APACHEII score (15.81±3.47 vs. 17.93±3.05) was obviously lowered (all P<0.05). There was statistical difference of the TT (s) between two groups at 3 days (15.68±1.89 vs. 14.65±1.33,P<0.05). There was a significant positive correlation between NF-ΚB DNA binding activity and the levels of TNF-α (r(1)=0.373, r(2)=0.362, r(3)=0.419), PCT (r (1)=0.800, r(2)=0.716, r(3)=0.920) or CRP (r(1)=0.368, r(2)=0.441, r(3)=0.366, all P<0.05) before and 3 days and 7 days after the treatment.
NF-ΚB activation and coagulopathy were observed in patients with severe pneumonia, and NF-ΚB was involved in the process of inflammatory response. Inflammatory response was partly alleviated by Xuebijing injection. These effects of Xuebijing injection may be mediated by inhibition of the activation of NF-ΚB and its anticoagulation property.
探讨核因子-ΚB(NF-ΚB)在重症肺炎中的作用,并观察血必净注射液对其治疗的效果。
将30例住院重症肺炎患者按随机数字法分为常规治疗组(n = 14)和血必净治疗组(n = 16)。血必净治疗组在常规治疗基础上,给予血必净注射液100 ml,每日1次,共7天。检测给药前、给药后3天和7天人体单核细胞中NF-ΚB的DNA结合活性,测定肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)和C反应蛋白(CRP)的含量,同时检测凝血和纤溶参数的变化。记录急性生理与慢性健康状况评分系统II(APACHEII)评分。选取10名健康志愿者作为健康对照组。
重症肺炎住院患者治疗前NF-ΚB的DNA结合活性、TNF-α、PCT、CRP、纤维蛋白原(Fib)、D-二聚体含量高于健康对照组;凝血酶原时间(PT)、凝血酶时间(TT)显著低于健康对照组(P < 0.05或P < 0.01)。与常规治疗组比较,血必净治疗组治疗7天时NF-ΚB的DNA结合活性(灰度值,66.60±36.23比79.90±39.11)显著降低;TNF-α(ng/L,25.81±11.67比33.78±13.36)、PCT(μg/L,1.91±1.09比2.96±1.80)、CRP(mg/L,20.01±7.21比26.59±10.66)、Fib(g/L, 4.02±1.26比5.09±1.43)、D-二聚体(mg/L,0.24±0.06比0.31±0.11)水平显著降低,APACHEII评分(15.81±3.47比17.93±3.05)明显降低(均P < 0.05)。两组治疗3天时TT(s)比较差异有统计学意义(15.68±1.89比14.65±1.33,P < 0.05)。治疗前、治疗后3天和7天NF-ΚB的DNA结合活性与TNF-α(r(1)=0.373,r(2)=0.362,r(3)=0.419)、PCT(r(1)=0.800,r(2)=0.716,r(3)=0.92 0)或CRP(r(1)=0.368,r(2)=0.441,r(3)=0.366,均P < 0.05)均呈显著正相关。
重症肺炎患者存在NF-ΚB激活及凝血功能障碍,NF-ΚB参与炎症反应过程。血必净注射液可部分减轻炎症反应,其作用可能通过抑制NF-ΚB激活及其抗凝特性介导。