The Clinical Rsearch Of The Influence Of Xuan Bai Cheng Qi Decoction Enema Combined With Thymosin-α1 Therapy On Imuune Function Of Patients With Sepsis

Objective Sepsis is a serious disease threatening the prognosis of patients with severe disease,with the acute onset,rapid progress and extremely high mortality.This study explored the gene polymorphism in patients with sepsis caused by pneumonia,and the TNF-α,IL-6 and IL-10 are well-known inflammation factors closely associated with sepsis.In the present study,we aim to investigate the association of promoter-region polymorphisms TNF-ɑ(-308 G/A)rs1800629,IL-6(-174 G/C)rs1800795 and IL-10(-1082 A/G)rs1800896 with pneumonia-induced sepsis.On the basis of the susceptibility gene TNF-α-308 G/A,IL-6-174 G/C and IL-10(-819 T / C,-592 A/ C,-1082 A/ G)related to sepsis.To further explore the effect of thymosin for improving immune function in the patients with sepsis,as well as the application of “lung and intestine common treatment” concept,based on the treatment of thymosin,with Xuan Bai Cheng Qi Decoction enema,to study the effectof Xuan Bai Cheng Qi Decoction enema on the factor as TNF-α,IL-6,IL-10 and the immune state in the patients with sepsis.Methods 1 Association of tumor necrosis factor α-308 G/A and interleukin-6-174 G/C gene polymorphism with pneumonia-induced sepsis A total of 277 Chinese patients with severe pneumonia-induced sepsis were recruited into this study.All study participants were admitted to the intensive care unit until discharge or death in the First Affiliated Hospital of Henan University of TCM from Jul 2012 to Dec 2014.The patients were classified as severely septic,septic shock,and mortality.Clinical data and demographic information were recorded.Taq Man genotyping was performed to detect single nucleotide polymorphism distribution.2 Association of IL-10(-819 T/C,-592 A/C and-1082 A/G)and IL-6-174 G/C gene polymorphism with transcription level and pneumonia-induced sepsis risk 188 Chinese patients with community acquired pneumonia-induced sepsis(CAP),162 community acquired pneumonia without sepsis and 200 healthy controls.All sepsis patients were admitted to the ICU in the First Affiliated Hospital of Henan University of TCM from Dec 2012 to Dec 2014.Clinical data and demographic information were recorded.Taq Man genotyping and RT-PCR was performed to detect nucleotide polymorphism distribution.3 The clinical rsearch of the influence of Xuan Bai Cheng Qi Decoction Enema combined with thymosin-α1 therapy on imuune function of patients with sepsis 66 cases of sepsis patients were selected from the First Affiliated Hospital of Henan University of TCM,Intensive care unit from Jan 2015 to De 2015.66 cases Were randomly divided into 3 groups.22 cases of routine treatment group.21 cases in a group treated with thymosin.23 cases in a group treated with thymosin and Xuanbai Chengqi Decoction.And on admission,on days 3 and days 7 after the treatment,the severity of disease,immune and inflammatory markers were recorded.And the parenteral nutrition time,mechanical ventilation time,vasoactivedrug application time and 28 days mortality rate among three groups were also recorded.Flow cytometry ELISA were used to detected the immune and inflammatory markers.Other markers were recorded by biochemistry,bacteriology and immunology laboratories in the First Affiliated Hospital of Henan University of TCM.Arterial blood gas analysis was completed by ICU.Results 1 Association of tumor necrosis factor α-308 G/A and interleukin-6-174 G/C gene polymorphism with pneumonia-induced sepsis The genotype results demonstrated that carriers of the TNF-α rs1800629 A allele had a 4.28-fold higher risk for septic shock compared with severe sepsis,and carriers of the IL-6 rs1800795 C allele had a 2.42-fold higher risk for septic shock compared with severe sepsis.However,these SNP distribution differences were not associated with mortality.2 Association of IL-10(-819 T/C,-592 A/C and-1082 A/G)and IL-6-174 G/C gene polymorphism with transcription level and pneumonia-induced sepsis risk Prevalence of the IL-10 rs1800896 G allele was significantly lower in patients,while IL-6-174 C allele was significantly increased in cases.The IL-10-1082 rs1800896 G allele and the IL-6-174 rs1800795 C allele affected the risk and clinical progress of pneumonia induced sepsis.3 The clinical rsearch of the influence of Xuan Bai Cheng Qi Decoction Enema combined with thymosin-α1 therapy on imuune function of patients with sepsis APACHE score,the combined treatment group on days 7 was better than that Ⅱbefore treatment and also better than that in routine treatment group.But significantly worse than the group treated with thymosin.SOFA score,the combined treatment group on days 7 was better than that before treatment and also better than that in routine treatment group.But the SOFA score between the combined treatment group and the group treated with thymosin had no significant difference.Oxygenation index and Intra-abdominal pressure,the combined treatment group on days 7 was better than that before treatment and that in routine treatment group and also better than that in the group treated with thymosin,the difference had statistically significant.HLA-DR,IL-6,IL-10 levels,the combined treatment group on days 7 was higher than that before treatment and that in routine treatment group and also higher than that in the group treated with thymosin.TNF-α levels,the combined treatment group on days 7 was better than that before treatment and also better than that in routine treatment group.But the TNF-α level between the combined treatment group and the group treated with thymosin had no significant difference.PCT,Lac levels,the combined treatment group on days 7 were better than that before treatment and that in routine treatment group and also better than that in the group treated with thymosin.WBC levels,the combined treatment group on days 7 was better than that before treatment and also better than that in routine treatment group.But the WBC levels between the combined treatment group and the group treated with thymosin had no significant difference.PLT levels,the level between the combined treatment group on days 7 and the level before treatment had no significant difference.And the level in routine treatment group are better than that in the combined treatment group.In terms of reducing parenteral nutrition application time,the combined treatment group were better than that in routine treatment group and that in the group treated with thymosin.In reducing the time of mechanical ventilation and reducing the application of vasoactive drugs,the combined treatment group were better than that in routine treatment group.In the improvement of 28 day mortality rate,the combined treatment group were better than that in routine treatment group.But the rate between the combined treatment group and the group treated with thymosin had no significant difference.Conclusion 1 The genotype results demonstrated that carriers of the TNF-α-308 rs1800629 A allele and carriers of the IL-6-174 rs1800795 C allele had higher risk for septic shock compared with severe sepsis.2 The IL-10-1082 rs1800896 G allele had significantly lower risk for sepsis.3 Based on the treatment of thymosin,with Xuan Bai Cheng Qi Decoction enema for sepsis patients can reduce the levels of TNF-α and IL-6,enhance the levels of IL-10.Also can obviously improve the immune status and a variety of inflammatory markers levels,reduce the treatment support.Most of the effects were better than that of single thymosin treatment.But To improve the prognosis of patients had no significant difference with single thymosin treatment.