Septic Lung Injury (ALI/ARDS) In Patients With Immune Imbalance And Treatment Combining Traditional Chinese And Western Medicine

Objective: Through the observation of septic lung injury in the ALI/ARDS, the CD4+CD25+regulatory T-cells percentages,T-lymphocyte subsets of (Th1/Th2) balance changes as well as of CD14+/HLA-DR+monocytes express the rateof change in the peripheral blood of patients, explores the immune indicators ofimbalance on immune function in patients with septic lung injury and the efficacy of the Integrative traditional Chinese&western Medicine, as well as the possible mechanism.In order to further elucidate the severe acute abdomen, severe intra-abdominal infections with obvious" large intestine visceral symptom " disease induced lung damage (ALI/ARDS) internal transmission conditions, biological basis and treating both lung and intestine effector mechanisms, clinical observation and treatment of dredging intestines, interpretation of lung and large intestine table of science essence Foundation.Methods:Selected from the Dalian Medical University First Affiliated Hospital,3rdGeneral Surgery Division and EICU from March2010to March2011, admitted to hospital according to the following criteria (age≥18years of age and≤70-year-old patient, with “large intestine visceral symptom” ALI/ARDS patients, in line with the Traditional Chinese Medicine National Yang Ming Fu real and asthma; patient’s APACHEII score≥6points; the informed consent from patients or their families)33cases.15cases of healthy volunteers from Dalian city blood center.33cases were randomly divided into Western treatment group (conventional therapy plus placebo)&integrated Chinese and Western medicine group(conventional Western treatment plus clear lung bearing gas particles).Since the t wo groups are routine western medicine-based, so combined together,called the therapy group.placebo:morphologically similar pharmacodynamics granules;chinese medicine clear lung bearing gas particles:composition(fructus trichosanthis,pinellia ternata,rhubarb, fructus aurantii immaturus,magnolia officinalis,coptis);means: oral/stomach tube into clamping2hours/retention Enema,2times/day and evening,200ml/time,Course of treatment depending on the course of the disease.Selectedthe same period in age-matched15normal control group as the control of the treatment group.Observation (1,3,7,14days) were compared between the two groups of patients admitted to hospital, the dynamic changes that include: basic checks(vital signs indicators, routine biochemistry, blood routine, urine routine, stoolroutine); routine tests (pulmonary function tests, immune function); intestinal function tests; organ function evaluation (APACHEII score,cumulative organ); witnesstraditional Chinese medicine (abdominal pain,abdominal distension,pulse, TCM syndrome score);Clinical evaluation and specimens from peripheral blood samplesby flow cytometry determination of immune function: CD4+/CD25+percentage ofregulatory T-cells,T lymphocyte subsets Th1/Th2and CD14+/HLA-DR+monocytesexpression rate.Results:1. Immune indicators compared1.1HLA-DR expression rate compared with western medicine group1st,3rd,7th,14thdays&traditional Chinese and Western medicine group1st,3rd,7thdays was significantly lower than that in control group (P<0.01), the integrated Chineseand Western medicine group day14thcampared with the control group was notstatistically significant(P>0.05); integrated Chinese and Western medicine group was significantly higher than that in western medicine group on day14th(P<0.05);1st,3rd,7thdays in two groups of the same period was no significant difference(P>0.05).1.2Th1/Th2odds comparison of Western medical group1st, and3rddays,and integrated Western Chinese Group1st,3rd,&7thdays significantly higherthan the control group (P<0.01), Western Group7th&14thDay is higher thanthe control group (P<0.05), day14thof integrated Chinese Western Group showed no statistically significant with the control group (P>0.05); integrated ChineseWestern Group day7thsignificantly higher than Western medicine group day7th(P<0.05). Integrated Chinese Western Group1st,3rd, and14thday showed no stat istically significant differences with the Western Group in the same time period(P>0.05).1.3Treg cells share compared with western medicine group3rd&7thdayhigher than that of control group (P<0.05); the integrated Chinese and Westernmedicine group7thday was significantly higher than that in control group (P<0.01), the western medicine group1st,14thdays&integrated Chinese and Westernmedicine group1st,3rd,14thdays in comparison with the control group had nostatistically significant(P>0.05); the integrated Chinese western medicine group and Western medicine group in the same time period showed no statistically significant difference(P>0.05).1.4Treatment among of HLA-DR group, Th1/Th2group, Treg group. treatmentgroup HLA-DR1st,3rd7th,14thdays are lower than those in normal control group(P<0.01); treatment group Th1/Th21st,3rd,7th,14thdays are higher than those of normalcontrols (P<0.01); treatment group Treg3rd,7thdays was significantly higher than thatof normal control group,(P<0.01), the combined treatment group1st,14thday&thenormal control group had no statistically significant difference (P>0.05).2.Other indexes2.1Comparison of APACHEII, base excess, mortality risk coefficient betweenWestern medicine group and integrated Chinese Western medicine group. APACHEII,base excess on1rd,3th,7st&14thdays were not statistically significant different(P>0.05) between western medicine group&integrated Chinese western medicinegroup; integrated Chinese and Western medicine group mortality coefficient on14thdayis lower than the same period in the western medicine group (P<0.05), the westernmedicine group and integrated Chinese Western medicine groups1st,3rd,7thdaymortality coefficient showed no statistically significant difference (P>0.05).2.2Comparison of oxygenation index, C-reactive protein(CRP), TCM syndromescore between integrated Chinese western medicine group&western medicine group.CRP compared on a same time period showed no statistically significant difference(P>0.05),day14thof Chinese and Western medicine oxygenation index higher than theWestern group of the same time period (P<0.05),two groups oxygenation index on1st,3rd&7thdays showed no statistically significant difference (P>0.05); TCMsyndrome score in the7thand14thdays of the Chinese and Western medicine is lessthan the western medicine group of the same time period (P<0.05), two groups1st&3rddays TCM syndrome score had no statistically significant difference (P>0.05). 2.3Clinical comparison of Western medicine group and integrated ChineseWestern medicine group Total effective rate after treatment. Total effective ratecomparison of two groups after the treatment showed any statistically significantdifference(P>0.05), but showed the integrated Chinese and Western medicine group issuperior to western medicine group trends, considered possibly related to too littleinformation about the sample size. Integrated Chinese and Western medicine groupwere markedly higher than in the western medicine group (P<0.05).Conclusion:1. Septic lung injury patients have declined HLA-DR expression rate, increasedpercentage of Treg cells, increased Th1/Th2ratio.2. Integrative Chinese western treatment of septic lung injury is better thanWestern medicine treatment in patients for immune level of regulation.3. Integrative Chinese western treatment can significantly improve the clinicalsymptoms, such as oxygenation index, TCM syndromes.4. Compared to treatment with Western medicine, Integrative Chinese westernMedicine can reduce the risk of death coefficient, improve clinical outcomes.