| Objective: To investigate the role of serum inflammatory cytokines suchas Tumor Necrosis Factor (TNF) and interleukine-8(IL-8) in acute pulmonarycontusion and subsequent lung injury in regard of the treatment effect andits possible mechanism of the prescription xuefuzhuyutang for pulmonarycontusion.Methods: A randomized single blinded clinical trial with control groupcomparison; 30 patients (17 males, 13 females, age between 22 and 65 years,average 42.64±10.84 years) with pulmonary contusion or lung injury wereaccurately selected at the 1st affiliated Hospital of Guangzhou University ofTCM 3rd Surgery Department from between March 2006 to March 2007 and randomlydivided into two groups. Patients with concurrent multiple injuries besidesthe thorax, over medium grade hemothorax, pneumothorax, atelectasis or shockdid not belong to the range of this study. The period between the injury andexamination at the hospital ranged from 30 min to 12 hours, main symptoms werechest pain, chest distress and short breath. All were given X-ray examinationof the thorax (main manifestations were patchy blurred shadows or glass-likechanges in the lobes of the injured side of the lung), 20 patients didsimultaneously plane CT scans of the thorax (main manifestations were patchyshadows of increased density in the lobes of the injured side of the lung).The 30 patients were divided into a control group of 13 and a trial group of17, the two groups had no significant difference in age, gender and diseasecondition. Conventional treatment measures were applied for the control group:Limitation of liquid intake quantity, anti-infectives, serious cases weresimultaneously given treatments with small amounts of dexamethasone 10-20mg for 3 days. Besides conventional treament, the prescripton of wuzhuyutang wasadded for the trial group with an investigation time of 10 days. From all ofthe group of patients with pulmonary contusion peripheral venous blood samplesof 5ml were taken on the 1st, 3rd, 5th, 7th and 9th day after admission, after 10minof centrifugation (2500r/min) the blood serum was distilled and kept in arefrigerator at -30℃until laboratory testing. The changes in TNF and IL-8serum level were dynamically observed by enzyme linked immunoabsorbed assay(ELISA).Results: The levels of TNF and IL-8 in blood serum of the patients withpulmonary contusion were significantly increased, TNF was releasedcomparatively early, IL-8 was released comparatively late but maintaining fora longer period. TNF levels in blood serum significantly increased and reachedits peak level during the first two days after injury, after 3-5 days itsignificantly decreased, after 9 days it basically recovered to normal. IL-8levels significantly increased and reached its peak level from 3 to 5 daysafter injury, the maintaining period after injury was comparatively long,after 9 days it still did not recover to normal levels. Before and? aftertreatment measures (After the intervention by the prescription ofxuefuzhuyutang) the TNF and IL-8 concentration in blood serum of the trialgroup was significantly decreased compared to the control group, the time ofrecovery was remarkably reduced. (p＜0.01)Conclusions: Inflammatory cytokines such as TNF and IL-8 play an importantrole in pulmonary contusion: The change in TNF and IL-8 levels after pulmonarycontusion can reliably reflect the degree of damage in local pulmonary tissue.By paying attention to the surveillance of TNF and IL-8 concentration, thetreatment effect for pulmonary contusion and the development of lung damagecan be investigated more sensitively. To treat pulmonary contusion by theprescription xuefuzhuyutang reflects the characteristics and advantage ofTraditional Chinese Medicine and shows a reliable treatment effect. |
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