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背景:过强的创伤应激能引起免疫调节失衡,导致免疫抑制。补益类中药复方可通过对神经、内分泌和免疫系统的调节作用,减轻创伤早期过强的应激性损伤,控制伤后早期炎性细胞的过量释放。目的:了解补益、镇静安神及大黄等中药组方对创伤应激早期细胞因子白细胞介素6和C反应蛋白及免疫功能的影响。设计:析因设计。单位:解放军成都军区昆明总医院急诊科和统计室。材料:实验于2003-03在解放军成都军区昆明总医院中心实验室进行,动物为健康成年清洁级SD大鼠36只。方法:大鼠36只随机分为4组:①正常对照组(n=6):不造模,灌胃生理盐水0.5mL,2次/d。②模型组(n=6):制备骨折创伤模型,伤后1h灌胃生理盐水0.5mL,2次/d。③补益+安神中药组(n=12):同前造模,伤后1h灌胃中药(炙黄芪50g,当归20g,石昌蒲30g,质量浓度1g/L)0.5mL,2次/d。④补益+安神+大黄组(n=12):同前造模,伤后1h灌胃中药(炙黄芪40g,当归15g,酒大黄10g,栀子15g,石昌蒲20g,质量浓度1g/L)0.5mL,2次/d。伤后6,48h取血测白细胞介素6和C反应蛋白水平,并做腹腔吞噬细胞活性检测。主要结局观察:各组大鼠不同时间血白细胞介素6和C反应蛋白水平,吞噬细胞吞噬红细胞的吞噬百分率及吞噬指数。结果:经补充后36只大鼠进入结果分析。①血白细胞介素6水平:伤后6h模型组显著高于正常对照组(P<0.01),补益+安神中药组和补益+安神+大黄组显著低于模型组(P<0.01)。至伤后48h,模型组由所下降,但仍高于对照组(P<0.05),补益+安神+大黄组仍低于模型组(P<0.05)。②血清C反应蛋白水平:伤后6h模型组显著高于正常对照组(P<0.01),补益+安神中药组和补益+安神+大黄组则低于模型组(P<0.05)。至伤后48h,模型组有所下降,但仍高于对照组(P<0.05),与其他两组无差异(P>0.05)。③吞噬百分率:补益+安神中药组和补益+安神+大黄组均高于模型组(0.46±0.17,0.56±0.15vs0.21±0.02,P<0.01)。④吞噬指数:补益+安神中药组和补益+安神+大黄组均高于模型组(21.2±6.77,23.3±6.34vs13.8±2.76,P<0.01)。结论:两种组方对断肢应激鼠伤后早期血浆白细胞介素6和血清C反应蛋白的增高均有控制效应,并可使创伤鼠巨噬细胞的非特异性免疫功能得到保护。证明当归、黄芪、大黄等药与镇静安神药组方,具有控制创伤应激后过强全身炎性反应和调节免疫功能之功效。
BACKGROUND: Excessive traumatic stress can cause imbalances in immune regulation, leading to immunosuppression. The replenishing Chinese herbal compound can reduce the stress injury in the early stage of trauma by controlling the nervous, endocrine and immune system, and control the excessive release of early inflammatory cells after injury. Objective: To investigate the effects of replenishing qi, tranquilizing sedative and rhubarb on the interleukin-6, C-reactive protein and immune function of cytokines in the early stage of traumatic stress. Design: Factorial design. Unit: Emergency Department and Statistics Department of Kunming General Hospital, Chengdu Military Area Command, People’s Liberation Army. MATERIALS: The experiment was performed at the Central Laboratory of the General Hospital of Kunming General Hospital of the Chengdu Military Area Command of the Chinese People’s Liberation Army in 2003-03. Animals were 36 healthy clean grade SD rats. METHODS: Thirty-six rats were randomly divided into 4 groups: 1 normal control group (n=6): no model, 0.5 mL of normal saline orally, twice a day. 2 Model group (n=6): A fracture trauma model was prepared, and 0.5 mL saline was intragastrically administered 1 h after injury, twice a day. 3 Tonic + Anshen Chinese medicine group (n=12): same as the previous model, 1 hour after injury, intragastric administration of traditional Chinese medicine (Scutellariae Radix 50g, Angelica 20g, Shichangpu 30g, mass concentration 1g/L) 0.5mL, 2 times / d. 4 Replenishing + Anshen + Rhubarb group (n = 12): same as the previous model, 1 hour after injury, intragastric administration of traditional Chinese medicine (Scutellaria baicalensis 40g, Angelica 15g, Rhubarb 10g, Wolfberry 15g, Shichangpu 20g, mass concentration 1g/L) 0.5 mL, 2 times / d. At 6 and 48 hours after injury, blood was taken to measure interleukin-6 and C-reactive protein levels, and the activity of peritoneal phagocytic cells was measured. The main outcomes were observed: serum levels of interleukin-6 and C-reactive protein at various times in each group, percentage of phagocytosed phagocytic phagocytic red blood cells and phagocytic index. Results: After supplementation, 36 rats entered the results analysis. 1Interleukin-6 levels in blood: The levels in the model group were significantly higher than those in the normal control group at 6h post-injury (P<0.01), while those in the Tonic+Anshen Chinese medicine group and the Tonic+Anshen+Dhuhuang group were significantly lower than those in the model group (P<0.01). At the 48th hour after injury, the model group decreased, but it was still higher than the control group (P<0.05). The Tonic+Anshen+Dahuang group was still lower than the model group (P<0.05). 2 The level of serum C-reactive protein was significantly higher in the model group than in the normal control group at 6h after injury (P<0.01), and lower in the tonic+Anshen Chinese medicine group and the tonic+Anshen+Dahuang group than in the model group (P<0.05). At 48 hours after injury, the model group decreased, but it was still higher than the control group (P<0.05). There was no difference between the two groups (P>0.05). 3 Percent phagocytosis: The replenishing + tranquilizing Chinese medicine group and replenishing + anesthesia + rhubarb group were higher than the model group (0.46 ± 0.17, 0.56 ± 0.15 vs 0.21 ± 0.02, P <0.01). 4The phagocytic index: The replenishing + tranquilizing Chinese medicine group and the replenishing + anesthesia + rhubarb group were higher than the model group (21.2 ± 6.77, 23.3 ± 6.34vs13.8 ± 2.76, P <0.01). Conclusion: Both groups have control effects on the increase of plasma interleukin-6 and serum C-reactive protein in early stage of severed limb stress mice, and can protect the non-specific immune function of traumatic macrophages. It has been proved that Angelica, Radix Astragali, Radix et Rhizoma Rhei and other drugs and sedative tranquilizers have the effect of controlling excessive systemic inflammatory reactions and regulating immune function after traumatic stress.