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目的:研究血必净在百草枯引起的急性肺损伤中的作用机制。方法:将我院2014-11-2015-05收治的40例急性百草枯中毒急性肺损伤患者,随机分成两组,Con组(常规治疗组)和Mod组(常规治疗+血必净组),每组20例。分别在入院后6h、24h、48h、72h等时间点,桡动脉采血1.5ml检测血气分析,静脉血2ml高速离心,取上层血清,用酶联免疫吸附法检测血清中转化生长因子-β1(transforming growth factor-β1,TGF-β1)、细胞因子TNF-α、IL-10(抑制炎症反应)的含量;行胸部CT检查,经患者及家属知情同意后并经伦理委员会同意行细针穿刺肺组织活检,行苏木精-伊红染色观察病理学变化。结果:1血气分析:各组PO2显著低于正常范围(P<0.05);但Con组PO2值较Mod组显著降低(P<0.05)。各组PCO2显著高于正常范围(P<0.05);但Con组PCO2值较Mod组显著升高(P<0.05)。2血清中TGF-β1和TNF-α水平:Con组和Mod组各时间点血清中TNF-α水平和TGF-β1、IL-10水平均高于正常范围,同时间点比较,Mod组血清中TNF-α、TGF-β1水平在490nm处吸光度低于Con组(P<0.05),Mod组血清中IL-10在450nm处的吸光度高于Con组(P<0.05)。3苏木精-伊红染色:Con组、Mod组肺组织中有大量炎细胞浸润,以中性粒细胞、巨噬细胞增多为著,肺泡壁断裂,肺泡腔充满粉红色水肿液,部分有透明膜形成,严重者可见到弥漫性肺出血、肺泡腔塌陷萎缩甚至结构消失;Mod组随时间的延长肺组织损伤程度较Con组减轻。结论:血必净注射液能通过抑制TGF-β1的合成、降低血清中TNF-α水平,升高IL-10水平,可以减轻百草枯引起的炎性因子的作用,对肺组织起到保护作用。
Objective: To study the mechanism of action of Xuebijing in paraquat-induced acute lung injury. Methods: Forty patients with acute paraquat poisoning acute lung injury admitted from 2014-11-2015-05 in our hospital were randomly divided into two groups: Con group (conventional treatment group) and Mod group (conventional treatment + Xuebijing group) 20 cases in each group. Blood samples were collected from 1.5 ml of radial artery for blood gas analysis at 6 h, 24 h, 48 h, 72 h after admission. Venous blood was centrifuged at 2 ml and supernatant serum was collected. Serum TGF-β1 (transforming growth factor-β1 growth factor-β1, TGF-β1), cytokines TNF-α, IL-10 (inhibit the inflammatory reaction); chest CT examination, with the informed consent of patients and their families and agreed by the Ethics Committee fine needle aspiration of lung tissue Biopsy, hematoxylin-eosin staining pathological changes. Results: 1 Blood gas analysis: PO2 in each group was significantly lower than the normal range (P <0.05); but PO2 in Con group was significantly lower than that in Mod group (P <0.05). PCO2 in each group was significantly higher than the normal range (P <0.05), but PCO2 in Con group was significantly higher than that in Mod group (P <0.05). Serum levels of TGF-β1 and TNF-α: The levels of TNF-α and TGF-β1, IL-10 in serum of Con group and Mod group were higher than those of normal group at the same time points The absorbance of TNF-α and TGF-β1 at 490 nm was lower than that of Con group (P <0.05). The absorbance of IL-10 at 450 nm in Mod group was higher than that of Con group (P <0.05). 3 hematoxylin-eosin staining: Con group, Mod group a large number of inflammatory cells in the lung tissue infiltration of neutrophils, macrophages, alveolar wall rupture, alveolar cavity filled with pink edema, and some have Transparent membrane formation, severe diffuse pulmonary hemorrhage can be seen, the collapse of the alveolar collapse and even the structure disappeared; Mod group lung injury over time to reduce the extent of Con group. Conclusion: Xuebijing injection can reduce lung injury by inhibiting the synthesis of TGF-β1, decreasing the level of TNF-α in serum, increasing the level of IL-10, reducing the effects of paraquat-induced inflammatory cytokines .