目的 探讨血必净注射液对脓毒症伴轻度急性呼吸窘迫综合征（ARDS）患者的治疗效果及对多配体蛋白聚糖-1（SDC-1）和氧化应激相关指标的影响。方法 选取2021年1月—2022年9月河北医科大学哈励逊国际和平医院收治的84例脓毒症伴轻度ARDS患者，按照随机数字表法将患者分为对照组和试验组，每组各42例。对照组患者给予早期复苏、抗感染、营养支持及对症治疗。试验组在对照组基础上加用血必净注射液，每次取血必净注射液100 mL加0.9%氯化钠注射液100 mL，静脉滴注，每天2次，连续治疗3 d。分别于治疗前后，检测两组患者外周血C反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞介素8（IL-8）、肿瘤坏死因子-α（TNF-α）、丙二醛（MDA）、超氧化物歧化酶（SOD）、透明质酸（HA）、SDC-1、硫酸乙酰肝素（HS）水平；比较两组治疗前后Murray肺损伤评分（MLIS）、全身性感染相关性器官功能衰竭（SOFA）评分、急性生理学及慢性健康状况Ⅱ（APACHE Ⅱ）评分，随访两组患者出院1个月生存情况。结果 试验组治疗总有效率（85.71%）高于对照组（66.67%），两组差异有统计学意义（P<0.05）。治疗前，两组IL-8、IL-6、TNF-α、CRP、MDA、SOD、HA、SDC-1、HS比较，差异无统计学意义（P>0.05）。治疗后，两组IL-8、IL-6、TNF-α、CRP、MDA、HA、SDC-1、HS水平均较本组治疗前显著降低（P<0.05），SOD较治疗前显著升高（P<0.05）；且试验组IL-8、IL-6、TNF-α、CRP、MDA、HA、SDC-1、HS水平较对照组明显降低（P<0.05），SOD较对照组明显升高（P<0.05）。治疗前，两组SOFA、APACHE Ⅱ、MLIS评分均无显著差异（P>0.05）。治疗后，两组SOFA、APACHE Ⅱ、MLIS评分均较本组治疗前显著降低（P<0.05），且试验组SOFA、APACHE Ⅱ、MLIS评分较对照组明显降低（P<0.05）。出院后1个月，试验组死亡率（30.95%）明显低于对照组（52.38%），差异有统计学意义（P<0.05）。脓毒症伴轻度ARDS患者血管内皮糖萼（EG）降解物HA、SDC-1、HS水平与MLIS评分间呈正相关（r＝0.733，P=0.036；r＝0.831，P=0.011；r＝0.826，P=0.013）。受试者工作特征（ROC）曲线显示，SDC-1联合氧化应激指标检测对脓毒症伴轻度ARDS患者短期的预后预测价值更大。结论 血必净注射液通过减轻脓毒症伴轻度ARDS患者肺血管内皮EG的降解，明显缓解ARDS，有效改善患者短期预后。

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年度河北省医学科学研究课题项目（20210910）