目的 探討血必凈注射液對(duì)膿毒癥伴輕度急性呼吸窘迫綜合征（ARDS）患者的治療效果及對(duì)多配體蛋白聚糖-1（SDC-1）和氧化應(yīng)激相關(guān)指標(biāo)的影響。方法 選取2021年1月—2022年9月河北醫(yī)科大學(xué)哈勵(lì)遜國際和平醫(yī)院收治的84例膿毒癥伴輕度ARDS患者，按照隨機(jī)數(shù)字表法將患者分為對(duì)照組和試驗(yàn)組，每組各42例。對(duì)照組患者給予早期復(fù)蘇、抗感染、營養(yǎng)支持及對(duì)癥治療。試驗(yàn)組在對(duì)照組基礎(chǔ)上加用血必凈注射液，每次取血必凈注射液100 mL加0.9%氯化鈉注射液100 mL，靜脈滴注，每天2次，連續(xù)治療3 d。分別于治療前后，檢測兩組患者外周血C反應(yīng)蛋白（CRP）、白細(xì)胞介素6（IL-6）、白細(xì)胞介素8（IL-8）、腫瘤壞死因子-α（TNF-α）、丙二醛（MDA）、超氧化物歧化酶（SOD）、透明質(zhì)酸（HA）、SDC-1、硫酸乙酰肝素（HS）水平；比較兩組治療前后Murray肺損傷評(píng)分（MLIS）、全身性感染相關(guān)性器官功能衰竭（SOFA）評(píng)分、急性生理學(xué)及慢性健康狀況Ⅱ（APACHE Ⅱ）評(píng)分，隨訪兩組患者出院1個(gè)月生存情況。結(jié)果 試驗(yàn)組治療總有效率（85.71%）高于對(duì)照組（66.67%），兩組差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療前，兩組IL-8、IL-6、TNF-α、CRP、MDA、SOD、HA、SDC-1、HS比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。治療后，兩組IL-8、IL-6、TNF-α、CRP、MDA、HA、SDC-1、HS水平均較本組治療前顯著降低（P<0.05），SOD較治療前顯著升高（P<0.05）；且試驗(yàn)組IL-8、IL-6、TNF-α、CRP、MDA、HA、SDC-1、HS水平較對(duì)照組明顯降低（P<0.05），SOD較對(duì)照組明顯升高（P<0.05）。治療前，兩組SOFA、APACHE Ⅱ、MLIS評(píng)分均無顯著差異（P>0.05）。治療后，兩組SOFA、APACHE Ⅱ、MLIS評(píng)分均較本組治療前顯著降低（P<0.05），且試驗(yàn)組SOFA、APACHE Ⅱ、MLIS評(píng)分較對(duì)照組明顯降低（P<0.05）。出院后1個(gè)月，試驗(yàn)組死亡率（30.95%）明顯低于對(duì)照組（52.38%），差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。膿毒癥伴輕度ARDS患者血管內(nèi)皮糖萼（EG）降解物HA、SDC-1、HS水平與MLIS評(píng)分間呈正相關(guān)（r＝0.733，P=0.036；r＝0.831，P=0.011；r＝0.826，P=0.013）。受試者工作特征（ROC）曲線顯示，SDC-1聯(lián)合氧化應(yīng)激指標(biāo)檢測對(duì)膿毒癥伴輕度ARDS患者短期的預(yù)后預(yù)測價(jià)值更大。結(jié)論 血必凈注射液通過減輕膿毒癥伴輕度ARDS患者肺血管內(nèi)皮EG的降解，明顯緩解ARDS，有效改善患者短期預(yù)后。

Objective To investigate the therapeutic effect of Xuebijing Injection on sepsis patients with mild acute respiratory distress syndrome (ARDS) and its influence on multi ligand proteoglycan 1 (SDC-1) and oxidative stress related indicators. Methods From January 2021 to September 2022, 84 patients with sepsis and mild ARDS who were admitted to the Harrison International Peace Hospital were selected and divided into the control group and the experimental group according to the random number table, with 42 patients in each group. Patients in the control group were given early resuscitation, anti infection, nutritional support and symptomatic treatment. Patients in the experimental group were supplemented with Xuebijing Injection on the basis of the control group. Each time, 100 mL of Xuebijing Injection and 100 mL of 0.9% Sodium Chloride Injection were taken, and intravenous infusion was performed twice a day for three consecutive days. Before and after treatment, C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD), hyaluronic acid (HA), SDC-1, and heparan sulfate (HS) levels were detected in two groups of patients. Murray lung injury score (MLIS), systemic infection related organ failure (SOFA) score, acute physiology and chronic health status II (APACHE II) score were compared between the two groups before and after treatment, and follow up the one-month survival of the two groups of patients after discharge. Results The total effective rate of the experimental group (85.71%) was higher than that of the control group (66.67%), and the difference between the two groups was statistically significant (P < 0.05). Before treatment, there was no statistically significant difference of IL-8, IL-6, TNF-α, CRP, MDA, SOD, HA, SDC-1, and HS in two groups (P > 0.05). After treatment, the levels of IL-8, IL-6, TNF-α, CRP, MDA, HA, SDC-1, and HS in two groups were significantly reduced compared to before treatment (P < 0.05), while SOD was significantly increased compared to before treatment (P < 0.05). And the levels of IL-8, IL-6, TNF-α, CRP, MDA, HA, SDC-1, and HS in the experimental groups were significantly reduced compared to the control group (P < 0.05), while SOD was significantly increased compared to the control group (P < 0.05). Before treatment, there was no significant difference in SOFA, APACHE II, and MLIS scores between the two groups (P > 0.05). After treatment, the scores of SOFA, APACHE II, and MLIS in two groups were significantly reduced compared to before treatment in same group (P < 0.05), and the scores of SOFA, APACHE II, and MLIS in the experimental group were significantly reduced compared to the control group (P < 0.05). One month after discharge, the mortality rate in the experimental group (30.95%) was significantly lower than that in the control group (52.38%), with a statistically significant difference (P < 0.05). There is a positive correlation between the levels of endothelial glycocalyx (EG) degradation products HA, SDC-1, and HS in sepsis patients with mild ARDS and MLIS score (r=0.733, P=0.036; r=0.831, P=0.011; r=0.826, P=0.013). The receiver operating characteristic (ROC) curve shows that the combination of SDC-1 and oxidative stress indicators has greater predictive value for short-term prognosis in patients with sepsis and mild ARDS. Conclusion Xuebijing Injection can significantly alleviate the degradation of pulmonary endothelial EG in patients with sepsis and mild ARDS, and effectively improve the short-term prognosis of patients.

R974

2021年度河北省醫(yī)學(xué)科學(xué)研究課題項(xiàng)目（20210910）