| Objective: Multiple organ dysfunction syndrome (MODS) is a major reason of death in ICU patients, whose case fatality ratio reaches to 40~80%. The pathogenesis of MODS is very complicated and not completely clear, a fairly concordant viewpoint of which is that MODS results from systemic inflammatory response syndrome (SIRS). Various kinds of etiological factor can cause SIRS. When it happens, a lot of inflammatory factors are released, then complicated cascade response happens and leads to tissue damage and multiple organ dysfunction. The remedy of western medicine can interfere in certain or several aspects of pathogenesis of MODS, but can not prevent progress of disease, so the effect of it isn' t satisfied. Domestically, herbs are used in treatment of MODS leading to better therapeutic effect which displays distinctive predominance. Recent research discovers that herbs can produce marked effect in several aspects of pathogenesis of MODS. Thus, it is of importance to find out more effective herbs for prevention and cure of MODS.According to traditional Chinese medical pathogenesis characteristic and differentiation of symptoms and signs, we choose Jiawei- Huanglian- Jie- Du-Tang (HJDT) with western medicine to treat MODS and observe the number of failure organs, case fatality ratio and the level of inflammatory factors in peripheral blood, approach its therapeutic effect and mechanism to prove that Jiawei-HJDT is effective in treatment of MODS.Methods: This is a prospective, random, control study. According to modified Marshall' s MODS score, 34 patients who were diagnosed MODS in ICU of the first affiliated hospital of Guangzhou University of TCM were divided into 3 groups randomly , from December, 2004 to January, 2006. Under the same basic western medicine treatment, three groups were treated with Jiawei-HJDTang, Dahuang, no herb respectively. The numbers of failure organs and case fatality ratio were calculated. The changes of patients' APECHA Hand MODS score in a week were observe. In the period of study, TNF-a, IL-6, IL-10 levels in blood serum of patients were measured by enzyme linked iiranunosorbent assay (ELISA) at the 1st day, the 3rd day and the 7th day, meantime control group was set up. SPSS 11.0 statistic system was used to analyze data. Customarily chi square test is used to compare enumeration data. And t-test or rank-sum test is applied to compare measurement data, size of test a=0. 05, bi-side P< 0. 05 means significant deviation.Results:1. Infection and trauma are the major basic diseases of 34 patients. There are three common types of medical pattern of syndrome on MODS: excess-heat syndrome, fu qi being obstructed syndrome, qi stagnancy and blood stasis syndrome, taking up 100%, 52.49%, 23. 53%. Fu qi being obstructed and qi stagnancy and blood stasis are not independent but accompanied with excess-heat syndrome. The most accompanied symptom is excess-heat syndrome with fu qi being obstructed.2. The case fatality ratio of group with Jiawei-HJDT, group with Dahuang, group with no herb are 0, 10%, 40% respectively. There has a significant difference between group with Jiawei-HJDT and group with no herb (P=0. 035< 0. 05), but not between group with Dahuang, and group with no herb (P>0. 05).3. In group with no herb, the case fatality ratio increase followed increase of MODS score. In the other groups, the case fatality ratios aren' t correlated with MODS score. The grades of MODS score in group with Jiawei-HJDT are all controlled below 13.4. Change of grades of APECHAII and MODS score displays a significant difference of decrease between group with Jiawei-HJDT and group with no herb.5. TNF-a levels are not significantly different at every group among the 1st day, the 3rd day and the 7th day. IL-6, IL-10 levels of group with no herb ascend at the 3rd day, and descend at the 7th day . IL-6, IL-10 levels of groups with Dahuang are not significantly different among those days. At 7th day , IL-6> IL-10 level of group with Jiawei-HJDT all decrease significantly (P<0. 05).Conclusions:1. Excess-heat syndrome, fu qi being obstructed syndrome are major typesof medical pattern of syndrome, consistent with the efficacy of Jiawei -HJDT.2. Jiawei-HJDT combined with western medicine to treat MODS patients can decrease case fatality ratio significantly.3. Jiawei-HJDT combined with western medicine can control patients' grades of MODS score under 13, and significantly decrease grades of APECHAII> MODS score compared to western medicine. This suggests that Jiawei-HJDT can improve organ' s function and delay deterioration of organ.4. Jiawei-HJDT can adjust Cytokines IL-6, IL-10 to interfere in SIRS/CARS than Dahuang more effectively. This is the mechanism of action of Jiawei-HJDT in treating MODS. |
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