| Part 1 Study of Traditional Chinese Medicine Syndromes of Septic PatientsBackground: Sepsis occurs when an infection exceeds local tissue containment and induces a series of dysregulated physiologic responses that result in organ dysfunction,with an increasing incidence and high mortality.According to the theory of TCM,sepsis belongs to the exogenous disease which leads to viscera injury inside the body.The viscera injury can make the pathogenesis of sepsis turn complex and usually accompanied with a poor prognosis.Objectives:To discuss clinical characteristics of septic patients about traditional Chinese medicine syndrome in our EICU,and the factors which affecting the incidence and mortality of sepsis.In order to make better use of TCM Fu-zheng in treating septic patients.Methods:One hundred and fifty cases of septic patients were analyzed retrospectively,the investigation form about general clinical data and TCM information of septic patients were selected.According to Si-Zheng-Si-Fa of TCM theory,150 cases of septic patients were distinguish into four group,Toxic heat syndrome,Blood stasis syndrome,Acute deficiency syndrome and stop-page of fu-qi syndrome.Record the clinical indexes needed,laboratory data,APACHE-II score,SOFA score and 28 days mortality are selected as the main observing indexes.Result:1?General condition of septic patients:One hundred and fifty cases of septic patients were analyzed retrospectively,18-80 years old,with a mean age 59.6±8.5.There were 72 male patients,with a mean age 58.4±8.6,and 78 female patients,with a mean age 59.1±8.2,the male-to-female ratio was1:1.1.There was no statistical difference between the comparison of male to female patients in each age group.The number of patients over 50 years old was significantly higher than those under the age of 50.Among them,94 patients were cured and discharged to the original ward,and 56 patients died.The average APACHE-?score of septic patients who survived was 21.3±6.08,and the average SOFA score was 8.15±1.17;The average APACHE-score of septic ?patients,who was dead,was 27.23±7.21 and the average SOFA score was 12.43±1.03.2?In accordance with clinical characteristics of septic patients about deficiency and excess syndrome:The average APACHE-?score of the cases with only excess syndrome was 13.22±6.26,and the average SOFA score was 3.48±1.57,The average serum levels of PCT was 3.56±1.57.The average APACHE-?score of the cases with only mixed syndrome was 24.55±7.29 and the average SOFA score was 9.76±2.57,The average serum levels of PCT was 11.46±4.68.The average APACHE-?score of the cases with only deficiency syndrome was 23.56±7.33 and the average SOFA score was 8.93±3.65,The average serum levels of PCT was 10.36±4.48.Conclusion:1?From the clinical data,the most common site of infection was respiratory system,and the second was abdominal infection.2?About the syndrome types of sepsis,the deficiency and excess mixed syndrome constituted the most,the death rate of the excess and deficiency mixed syndrome group was higher than that of the excess syndrome only group.The deficiency syndrome had great significance in the development of sepsis,which went throughout the whole process of sepsis.3?For the patients with excess syndrome only,who has no distinguishing deficiency syndrome,Zheng-qi was consumed and pathogenesis of the patients has become a virtual real state.Part 2 The Expression of PD-1/PD-L1 CTLA-4?Tim-3 on Activated T Cells of Septic Patients Objective: This study aims to elucidate the roles of PD-1,Tim-3 and CTLA-4 in sepsis.Methods: Sepsis patients(n = 56)were selected as sepsis group.Methods: Flow cytometry and blood routine examination were performed for T lymphocyte cells and surface co-stimulatory molecules expressions.Pearson correlation test was applied for the correlation of co-stimulatory molecules expressions on T lymphocytes with critical illness in sepsis.Logistic regression analysis was conducted for risk factors in sepsis.Results: The differences in APACHE II and SOFA score among subgroups were statistically significant(P<0.05).Compared with control group,lymphocyte ratio and percentage of CD4+T cells reduced in subgroups(P<0.05).The differences in expression levels of CD4+PD-1+,CD8+PD-1+,and CD8+CTLA-4+ showed statistical significance(P<0.05).Apparently,expression levels of CD4+TIM-3+,CD8+TIM-3+,CD4+PD-1+,CD8+PD-1+,and CD4+CTLA-4+ were positively correlated with APACHE II score(all P<0.05).Logistic regression analysis showed that heart rate and expression level of CD4+PD-1+ might be risk factors while the percentage of CD4+ T cells might be a protective factor for sepsis(P<0.05).Conclusion:1?PD-1 aggravates immune responses consistent with promotion of T cell exhaustion in sepsis.2?Expression level of CD4+PD-1+ and heart rate are potential risk factors while percentage of CD4+ T cells is a possible protective factor for sepsis.Part 3 The Clinical Efficacy of Shen Qi Fu Zheng Injection on Immunity of Septic PatientsObjective: Effect of Shen Qi Fu Zheng Injection on immune function and prognosis in septic patients were dynamically observed,in order to investigate the changes of innate immune status and function of complement and serum cytokine levels in patients with sepsis.Methods: In our study,a prospective,randomized,controlled clinical trial was conducted.The septic patients were randomly divided into sepsis group(group A)and Shen Qi Fu Zheng treatment group(group B).All the patients with sepsis(group A+B)were treated with a standardized treatment according to the 2012 edition of the guidelines for severe sepsis and septic shock.In addition,Intravenous infusion of Shen Qi Fu Zheng injection 250 ml a day was used in Shen Qi Fu Zheng treatment group(group B),for a period of 10 days.All patients with sepsis were selected at each observation point(first,3,7 after diagnosis,10 day record of vital signs,blood routine,blood biochemistry,PCT,the detection results of arterial blood gas analysis and blood lactic acid,complement levels and APACHE-?score and SOFA score,etc.Enzyme linked immunosorbent assay(ELISA)was used to detect serum cytokines(IL-6,IL-8,IL-10 and TNF-?)in the same period.Result: There was no significant difference in age,sex,primary disease between the sepsis group(group A)and the Shen Qi Fu Zheng treatment group(group B).1 ? APACHE-?score: There was significant difference between the APACHE-?score of group A and group B in D7 and D10.Group A was higher than group B.The APACHE-?score from D1 to D10 showed a downward trend in both group.2?SOFA score: There was significant difference between the SOFA score of group A and group B in D7 and D10.Group A was higher than group B.SOFA score from D1 to D10 showed a downward trend in both group.The levels of Complement: The expression of C3 in D7 and D10 in group A,CH50 in D10 was significantly higher than that of D1,with a statistical difference;The expression of C3 in A group and B group in D3,there was no significant difference between the two groups,group A is lower than group B.3?Cytokine: The levels of IL-6 and TNF-? in D7 and D10 compared with D1 in group A showed a downward trend and the difference was statistically significant.The expression of TNF-? in D7 and IL-6 in D7 and D10 in group A was significantly higher than that in group B.Compared with D1,the IL-6 and TNF-? levels in D7 and D10 in group A,D3?D7 and D10 in group B was significantly decreased,with statistical difference.4?Immunoglobulin levels in blood: The expression of Ig G and Ig M in D7 and D10,Ig A in D3?D7 and D10 of group B were significantly higher than those in group A,with statistical difference.There was significant difference between A group and B group for the levels of Ig M in D3.5?The levels of Complement: The expression of C3 in D7 and D10 in group A,CH50 in D10 was significantly higher than that of D1,with a statistical difference;The expression of C3 in A group and B group in D3,there was significant difference between the two groups,group A is lower than group B.6?T lymphocyte subsets: Compared with D1,the ratio of CD4+T cells in D7 and CD4+/CD8+ of group A was significantly higher than group B,and the difference was statistically significant.7?Lymphocyte apoptosis ratio: The apoptosis rate of CD4+T cells in D3 of group A was higher than D1,but there was no significant difference.The apoptosis rate of CD4+ cells decreased significantly at D7 and D10,with statistical difference.The apoptosis rate of group A was higher than that of group B.In D7 and D10,the apoptosis rate of CD4+T cells decreased significantly,with a statistical difference.Conclusion:1?In the study,both the APACHE-II score and the SOFA score of the two groups was decreased,which means the patients were getting better,in group of which using Shen Qi Fu Zheng injection,the APACHE-II score and the SOFA score both decreased faster.It suggested that Shen Qi Fu Zheng injection can alleviate the severity of the disease and shorten the recovery time.2?The patients' immunity state was adjust by Shen Qi Fu Zheng injection through the way of inhibiting the release of pro-inflammatory cytokines,which can blocking the “cascade” effect between inflammatory mediators,and keeping a balance between the pro-inflammatory and anti-inflammatory cytokines,so the immune equilibrium was maintained.3?The level of Ig G in Septic patients was increased by using Shen Qi Fu Zheng injection,by which the humoral immune function was regulated.4?The CD4+T cells percent and CD4+/CD8+ ratio were elevated,and the number of activated T cells was increased relatively. |
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