Hd TRO DIEU TRj BENH NHAN BONG NANG NGHriN curu VB09 TRONG

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38 TCYHTH&B so 2 - 2014

NGHriN curu TAC DUNG CUA C H E PHAIUI VB09 TRONG Hd TRO DIEU TRj BENH NHAN BONG NANG

Chu Anh T u i n " , Nguydn Nhv U m "

•Vi0n Bdng 1^ HOfu Tiic

TOMTAT

MSc do c6 nhi&u tien hfl, hien nay cdng tSc diSu tri benii nhan bdng n$ng vSn con Id tilicii thOc ldn do c6c bi4n chi>ng phCfc tap cOng nhw chl phldlSu tii ldn. Hoang lidn glai ddc thang Id bii thudc cd phuang, du^ Cmg dung Oliu tri nhiiu bdnh, trong dd cd bdng. Trong nghidn ciiu niy, chiing tdi dinh gii tic dung hd trv diiu tri cia ch4 phim VB09 duvc thira kd tir bii thuoc trin bdnh nhin bdng ning

Kit qui nghidn aiu cho thiy: chi phim VBOB cd tic dung chong oxy hoi thdng qua ca chi lim ting boat do enzym SOD, giim sw hlnh thinh MDA, glim ndng dd axit uric trong huyit thanh; cfl (dc dung bio vfl ti bio gan, ldch thich qui Irinh liin vit thiiong.

Despire many progress In bum therapy, saving severe bum patient Is still challenges due to complicated complications as well as high cost Huangllanjiedu Is an old traditional medications which has been applied to treat diseases Including burns. In this study, we evaluated the effect of supportive treatment of VB09 which prepared from Huangllanjiedu on severe bums patients.

Results showed that VB09 preparations had antioxidant effects through the mechanism that increases the activity of the SOD enzyme, reduces formation of MDA, acid uric. Thi product also has protective effect on liver cells as well as stimulation of wound healing.

1 . D A T V A N D 6 Hoang lidn giii ddc thang Id bdi thuic

' , ,. , c i phuong, gim cdc thdnh phin: hodng Bong Id cdn bflnh song hdnh vdi sy ton n^n, ^odng bd, hodng d m vd chi t i , dOng tgi vd phdt tnen cug xa hfli lodi ngudi, dflng <,udi dang sdc uing, cd tdc dgng thanh vai trd quan trong trong co cau bflnh ly vd ty ^hiflt thai dflc, ndng dd co t h i Tif xa xua, fl tu vong trong y hoc. Bong id bflnh l« todn ^fli thuic dd duoc ung dgng trong diiu tn' thdn, d,en l=,en kflo ddi, c6 sy tham gia cua tong, cfl tdc dgng tit. Chdng tfli dfl k i thCra nhieu yeu to bflnh sinh. Viflc dieu trj todn „ j tdo c h i bdi thuic dudi dgng cao Iflng 1:1 thdn vd tgi cho vit bong Id rit khfl khdn vd ^ j , , ( j ^ gp, ygog " "

phipc tap, chi ptii dieu tri Idn, id gdnh nflng

Chung khflng chi cho bflnh vifln, gia dlnh ^''""S nghifln cdu ndy, chiing tfli di sdu bflnh nhfln md cfln cho ca cflng ding. nghidn ciru ddnh gifl tdc dgng cua chi

^ phim VB09 trong h i tro diiu trj bflnh nhdn

Phin bi(n khoa hqc: TS. Nguyen Minh Tam ''*"8 "^"9"

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TCYHTH&B so 2-2014 39

1 eOl TUtTNG VA PHUONG PHAP NGHIEN c i r u 2.1.D6itiPQiig

Nghidn ci>u du'qrc li6n hdnh trdn 62 bdnh nhdn bdng n$ng dircrc di^u tri tgi khoa Gi^u trj tich ci/c - Vidn Bdng Ld HOu Trdc, thd'i gian tir thdng 6- thdng 11/2011. Tidu c h u i n li;a ChQn bdnh nhdn nghidn ci>u:

+ Bdnh nhdn c d didn tich bdng chung trdn 30% DTCT hodc didn bong sdu trdn 20% DTCT.

+ Vdo vidn trong 3 ngdy dau sau bong.

+ Khdng mic cdc bdnh mgn linh ndng kdm theo.

+ TM" nguydn tham gia nghidn ci>u.

2.2. V|it li$u v d hda c h i t n g h i d n ci>u - Thu6c n g h i d n c v u : Id eao Idng VBOQ, do Trung tdm nghidn cd'u i>ng dyng thu6c - Hoc vidn Qudn y san x u l t . Thdnh p h i n eao Idng g6m cdc vj thu6c hodng lidn, hodng bd, hodng e l m vd chi ti>. Thu6e dgt lidu e h u i n CO sd* cua mdt thudc u6ng nhu' vd dd an todn, vd k h u i n , pH Irung tlnh, ty Id hogt c h i t chlnh theo ydu c l u . . .

T h u l c diing eho c l dg't nghidn ei>u duo'c sdn x u l t cCing Id, cd s6 Iu'O'ng vira dO, thu6c trong hgn su- dgng vd dam bao c h l l Iu'O'ng.

' Hod c h i t : Kit xde djnh hogt tlnh SOD cOa hdng BIOVISION (SOD Elisa kit - code:

K335-100), kit djnh Iu'O'ng MDA ciJa hdng Cusablo B i o t e c h (Humgn Malondialdehyde (MDA) ELISA kit, catalog NO- CSB- E08557h).

T h i l t b j : Mdy xdt nghidm sinh hda Autolab S/N9505194 (Boerhinger mannheim - Di>c); Mdy xdt nghidm h u y l t hoc K4500 (Sysmex- Nhdt Bdn);....

2.3. P h i r a n g phdp n g h i e n c v u T h i l t k l n g h i d n c m i : Nghidn ci>u t i l n ci>u, Ihvrc nghidm Idm sdng cd d l i chiJng so sdnh.

Bdnh nhdn (BN) Dnh nguydn nghidn ciru dircrc chia n g l u nhidn thdnh 2 nhdm, tifong duang nhau v l li>a tudi, didn bong chung vd bong sdu:

+ Nhdm nghiin cdu: gom 32 bdnh nhdn.

BN du'O'c d i l u trj theo phdc d l c h u i n dang dp dgng tgi Vidn Bong Ld HO'u Trdc vd tCr ngdy lhi> 3 sau bdng du'O'c cho udng VB09 vd'i lieu 2- 2,5 ml/kg cdn ndng/ngdy, chia Idm 3 lan sdng, tnra, chieu.

+ Nhdm chOng: gdm 30 bdnh nhdn. BN du'O'c dieu trj theo phdc do c h u i n dang du'O'c dp dgng tgi Vi$n Bong Ld HOu Trdc.

T i t ca cdc BN nghidn cCru du-grc ldp p h i l u ddng ky theo ddi d i l n b i l n hdng ngdy trong s u i t qud trinh nghidn ciru cho d i n k l l IhCic. Cdc chT lidu theo ddi g l m :

+ Ve lim sing: T u l i , gid'i, hodn cdnh, tdc nhdn gdy bdng; Didn bdng chung, bdng sdu; theo ddi todn thdn vd cdc ca quan: y thi>e, thdn nhidt, mgch, h u y l t dp, nird-c t i l u , r l i logn tidu hda, nud'c tilu,...; Cdc b i l n chirng: n h i l m k h u i n huyel, s i c n h i l m k h u i n , suy da lgng, phe qudn p h i vidm, suy thdn d p , chay mdu tidu hda, dQng mdu rdi rdc Idng mgch; thd'i gian l i l n v l l thuang vd k i t qua d i l u trj.

+ Xit nghidm: SGOT, SGPT, Ure vd Creatinin, hogt tlnh enzym SOD, hdm lug'ng MDA h u y l t l u o n g ; HC, HST. TC, BC.

Cdc xdt nghidm duo'c t i l n hdnh 6- 3 ttidi diem: N l (ngdy t h u 3 sau bdng, trud'c ttidi d i l m u i n g VB09), N2 (ngdy thCr 10 sau bdng), N3 (ngdy t h u 17 sau bdng).

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40 TCYHTH&B s6 2 - 2014

Xdc dinh hogt tlnh SOD theo phuong phdp cua Sun Y vd cflng sy (1988) [11). Binh luong MDA theo phuong phdp ciia Tanaka M. vfl cflng sy (1994) [3].

2.4. Xir ly s i liflu

Theo phyong phdp thing kfl y hoc, sij dgng phin mim SPSS 15. vd STAVIEW5.1.

3. Ktr QUA NGHIEN CI>U

3.1. Kit qui xet nghiem tren bflnh nhin tiflng nang

Bdng 3.1. D^c diim bflnh nhan nghifln cOu

D$c dilm

Tuoi (nam) Di$n tich bong (%) Di$n tich bong sfiu (%) Ty 1$ nam/nif Ty ifl bong hd hip

Nhom nghien cvu (n = 32) 34,26 ±16,11 52,65 ±15,49 16,21 ±12,88

24/8 8/32

Nhom Chung (n = 30) 26,69 ± 24,59 47,73 ± 20,57 14,76 ±16,79

22/8 7/30

Nh0n xit. BN lya chpn diu Id nhO'ng BN bong ndng vd r l i ndng. Cdc ddc diem BN hai nhdm Id tuang duang nhau.

Bing 3.2. Tlnh tr^ng sdt cao (> 39°C) vd tin s6 m^ch cua b^nh nhdn

Thai dilm

sau bdng

Nl

N2

N3

Trifu ChOng Sitcao

Mgch Sot cao

M$ch Sitcao Mgch

Nhflm NC (n = 32) 13 (40,6%) 121,34±11,88

29 (90,6%) 118,13 ±10,83

15/27 (55,5%) 11415 ±11,39

Nhdm Chung (n = 30) 15 (50%) 12488 ± 14,38

28 (93,3%) 121,34 ±10,07

12/26(46,1%) 113,23 ±15,99

P

>0,05

" Ghi chti: Thdi <SSm ngay thCr 17 sau bdng (N3). nhdm NC da cd 5 BN tw vong (cdn 27 BN), nhdm Chiing cd 4 BN td vong (cdn 26 BN).

Nhin xit Vdo cdc thd'i diem ngdy thu ba, ngdy thd" 10 vd ngdy IhO- 17 sau bdng, t9 Id

bdnh nhdn sdt cao d' hai nhdm cOng nhu tin sd mgeh ngogi vi do dup'c tuang ducng nhau.

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TCYHTH&B sfi 2-2014 41

Bdng 3.3. C i c rdi lo9n tilm t h i n kinh, tieu hoa, ho h i p sau bong T l i M d i i m

sau bdng

Nl

N2

N3

Trifu Chirng Roi iogn TTK

iachay —

Phiinl " — ! _ - _ : Rli loan hd hip 1 Rdi loan TTK ia chay Chudng bung PhCi n l Rli loan hd hip Rli loan TTK la cliay Chudng bgng Phiinl Rli loan hd hip

Nhdm NC (n = 32) 2 (6,2%) 1 (3,1%) 5 (15,6%)

",:. 15 (46,9%) '-' ' 3 (9.4%)

9(28,1%) 3 (9.4%) 14 (43,7%) 23(71,8%) ,

6(18,7%)- . 4/27 (14,8%)

0 (0%) 4/27 (14,8%) 6/27 (22,2%) 3/27(11,1%)

Nhdm chi/ng (n = 30).

1 (3.3%) 2 (6,7%) 8 (26.7%) 9 (30%) 3 (10%) 9 (30%) 7 (23,3%) _:_:•_ 16(53,3%) ,__ . 21 (70%)

5 (16,7%) 3/26(11,5%) 5/26 (19.2%) 3/26(11,5%) 5/26(19,2%) 2/26 (7,7%)

P

>0,05

<0,05

>0,05

<0.05

> 0,05

>0,05

Nh^n xit: Cdc tridu ehung Idm sdng d giai dogn nhilm khuin nhilm ddc a hai nhdm bao gdm cdc rdi logn ldm than kinh, chud'ng bgng, rdi logn hd hap vd phu nen todn thdn diln biln luang duang nhau ve mCre dd cOng nhu tin suit.

- So BN bj tieu chay a nhdm chung cao han rd rdt so vd'i nhdm NC (p < 0,05) a cdc thai diem ngdy thu 10 (N2) vd ngdy thCr 17 SSU bdng (N3).

Bang 3.4. Trnh tr^ng bai nieu ThM diim sau bong

Nl

N2

N3

M i u 83c Binh thtfong V^rrg O^m So li/iyng Binh thifong Vang Dgm So ii/(?ng Binh thi/ong DSm S6 li/OTig

Nhom nghien ci>u 21

1 1 1,2ml/l(g/h

20 2 1 2,2ml/kg/h

11 2 1,9ml/kg/h

Nhom chi>ng 24

0 2 1,1 ml/kg/h

22 1 3

1,9ml/kGn ' 11

2 1 1,8rr V-; h 1

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42 TCYHTH&B s6 2-2014

Nhin xet: Tlnh b'gng bdi nidu t h l hidn qua mdu sdc nud'c tilu cOng nhu sd lupng tuang duang nhau d' hai nhdm.

Thdi diem sau bdng Nl

N2

N3

Bflng 3.5. B i l n d i i ndng dfl ure vfl creatinin mau Chi tieu

Um (mmol/l) Creatinin (,imol/l) Ure (mmol/l) Creatinin (|imol/i) Ure (mmol/l) Creatinin (^moi/l}

Nhdm NC 5,59 ±1,96 84,56 ± 27,92

5,49 ± 4 1 1 79,18 ±27,89

5,01 ±1,89 57,91 ± 19,48

Nhdm chirng 476 ±2,42 67,38 ±31,86

4,65 ±1,84 65,96 ±25,82

6,99 ± 2,01 77,75 ± 50,20

P ':

> 0,05 ,,

>0,05

> 0,05

>0,05

>0,05 Nh$n xet: Cdc ehl sd xel nghidm chii-c ndng thdn gdm ure vd creatinin mdu a cdc thdi

^ I m xdt nghidm tuang duang nhau vd'i p > 0,05.

Bang 3.6. K i t qud xdt nghidm SGOT vd SGPT mau (UI/I) Thd'i dilm sau bdng

N1

N2

N3

Chi tieu SGOT SOPT SGOT SGPT SGOT SGPT

Nhdm nghien cu'u 53,39± 11,18

28,03 ±4,08 65,43 ± 9,77 38,71 ± 5,56 78,33 ± I486 69,88 ±19,31

Nhdm chu'ng 48,37 ±14,00 29,52 ± 439 77,11 ±3,83 49,37 ± 2,97 95,08 ± 49,94 85,99 ±41,89

P

>0,05

Nh$n x f l t Ning dfl cdc men gan SGOT gan o nhdm Nghidn ciru cd xu hudng thip vd SGPT o thd'i diem ban dau tuong duong hon so vd'i nhdm Chirng, tuy nhifln khdc biflt 0' hai nhflm, cdc thfli diem sau nong dfl men chua cfl y nghta thing ke vfli p > 0,05.

Bang 3.7. Kit qui xet nghi#m glucose va protein mau Thdi diem sau bdng

N1

N2

N3

Chi tieu Glucose (mmol/l) Protein (g/i) Glucose (mmoi/i) Protein (g/l) Glucose (mmol/i) Protein (g/l)

Nhdm NC 7,50 ± 2,57 49,03 ±11,59

7,18 ±2,23 47,02 ± 7,62 7,05 ± 3,05 51,84 ±8,14

Nhdm chd'ng 7,87 ± 3,40 45,52 ± 10,45

6,49 ±1,56 48,88 ± 7,50

7,13 ±2,04 52,91 ± 10,97

P

>0,05

>0,05 Nhin xit: Ndng dd glucose, protein mdu a hai nhdm 6- cdc th^i dilm xdt nghidm Id luang duang nhau (p > 0,05).

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TCYHTH&B so 2-2014 43

Bang 3.8. Kit qua xet nghiflm uric mau (mmolTl) Thdi dilm sau bdng

Nl N2 N3

Nhdm nghien cuu 260,47 ±90,16

(n = 24) 378,27 ±71,33

(n = 21) 234,5 ±66,28

(n = 16)

Nhdm chting 268,95 ±97,18 (n = 25) 434,4 ± 79,45

(n = 20) 353 ±57,42

(n = 18)

P

>0,05

<0,05

- Ndng 6^ axit uric tdng cao nhai vdo ngdy thi> 10 sau bdng d ca hai nhdm.

- Ndng dp acid Uric a nhom Nghien cu-u thip han so vd'i nhdm Chd'ng vdo thd'i diem ngdy lhi> 10 (N2) vd ngdy IhCr 17 (N3) sau bong (p < 0,05).

Bing 3.9. Biln ddi ho^t d$ cda SOD trong mau b^nh nhin bong n^ng d- cac th&i diem nghiin cuu Nhdm

Nghidn ci>u

Oli chi>ng

SOD (%) X SD

X SD P

Nl 85,426 (n = 25)

9,134 86,136 (n = 22)

10,457 p > 0,05

N2 92,189 (n = 17) 12,367 77,239 (n=17) 11,247 p < 0,01

N3 133,967 (n = 12)

11,458 89,753 (n = 12)

9,823 p < 0,01

P p1-2 <0,05 p1-3< 0,01 p2-3 <0,01 p1-2 <0,05 p1-3 >0,05 p2-3 <0,05

Nh$n xdt: Hogt dfl SOD mdu tdng cao r i rflt vdo cdc thd'i diim ngdy thir 3, thir 10 vd 17 sau bflng nflng. Cl thd'i diem Ni vd Nj,

hogt dfl SOD o nhdm nghifln cCru cao hon rfl rjt so vfli nhflm chijpng, khdc biflt cfl y nghTa thing kfl vfli p<0,01.

BIng 3.10. Biln dli ning dfl MDA trong mau b^nh nhan bdng nang d cac thdi dilm nghidn ciru

Nhdm

Nghien ci>u

d i chirng

MDA (pg/ml) X SD X SD P

Nl 6,662 (n = 25)

1,346 6,136 (n = 22)

1,267 p > 0,05

N2 5,347 (n = 17)

2,127 5,964 (n = 17)

11,247 p < 0,01

N3 5,095 (n = 12)

1.433 5,643 (n = 12)

9,823 p<0,01

P p1-2<0,01 p1-3<0,01 p2-3 <0,05 p1-2>0,05 p1-3 < 0.05 p2-3 < 0,05

Nh$nxit:

- Hdm iuong MDA tflng cao nhit 6' ngdy thOr 3 sau bing fl cd hai nhflm BN.

- 0 ciing thfli diem N2 (ngdy thii- 10),

N3 (ngdy thir 17) sau bflng, hdm luong

MDA o nhdm BN Nghifln cuu thip hon so

vfli nhdm Chirng, khdc biflt cfl y nghTa

thing kfl vfli p<0,01.

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44 TCYHTH&B s6 2 - 2014

Bang 3.11. Thdi gian l i l n v l t t h u v n g va k i t qua d i l u trj K i t qua d i l u tri

Llln vet thuang (ngay)

Chi tieu B o i l e p l l i n Dfl ills Cd md hat dep sau d t hoai tir (ngay) Kit qua dilu tri Ciru song

TCr vong

Nhdm nghien cflu 7,36 ±2,13 11,18±2,11 17,47 ±4,52 6,43 ±1,62

26 6

Nhdm chflng 7,62 ±2,16 12,01 ±1,08 17,83 ±2,54

6,91 ±1,81 23

7

Nhan xet:

- Thd'i gian khoi ldn t h u o n g bdng ndng.

thd'i gian hinh thdnh md hat dep sau khi e l l hogi ti> a nhdm NC cd xu hudng t h i p han nhdm Chung.

- Tuy nhidn, kel qua didu tri d hai nhdm Id tuang d u a n g .

4. BAN LUAN

Ti> xa xua, tai nhidu nai d chdu A n h u Nhdt Ban, Trung Qudc,... bdi Ihudc "Hodng lidn giai dpc thang" dd d u a c Crng dgng khd rdng rdi trong didu trj benh, trong dd cd bong.

Bi cd khd nhieu nghidn cuu ve lac dung cua bdi thudc, cho thdy thudc co tac dyng khdng khuan, dieu hda midn djch, lai ntdu thai dde, anlioxydant, ngdn can qud Irinh thodi hda, cai thidn vi tuan hodn, d u p c dung trong dieu trj nhieu bdnh nhu sdt, nhidm khuan, d y phdng vd didu- trj viem lodt da ddy vd trong d i l u trj bong (Truang Bao Qudc (Zhang Baoguo) vd CS (2010), Lidu Vdn Hd (Liao Yunhe),..).

Trdn c a s a cac nghidn ci>u c a ban vd edn c u vao k l l qua nghien CCPU, chOng ldi nhdn t h i y cao Idng VB09 cd cdc tdc dyng dieu tri nhu sau:

4 . 1 . Tdc d u n g c t t d n g g d c t i ^ d o Ti> ndm 1984, Cutler R.G dd xdc djnh vai trd bdnh ly cua gdc t y do (free radicals) trong sinh hpc. D i n ndm t 9 8 6 , Harman D. ndu mdi lidn quan giOa cac gdc t u do vd'i ngudn gdc

vd qua trinh t i l n trien cua sinh vdt, qud trinh Ido hod vd qud trinh benh ly. Cac gdc t y do gdy oxy hoa Id'p m& qua mang te bdo vdi malonyl dialdehyd (MDA) la san p h i m c u l l cung cua qua trinh ndy, la nhung nguydn nhdn gay tdn hgi mdng te bao, nhdn t l bdo

rat mgnh [1]. i Ddi vd'i bdnh ly bong, cdc ldc gia

Wooliscroff F.O vd cdng s u (1990) [12] dd eht>ng minh mdt each h i l n nhien v l s y sinh san ra cdc gdc oxy t y do a ngud'i bj bdng khi didn lich tdn t h u a n g bong trdn 2 0 % DTCT trd Idn Cdc xet nghidm cho Ihay:

+ Ndng dg cdc lipid peroxides a huylt tuang, da, nhu m d phdi deu ldng cao.

+ C d b i l u hidn Ihoai ra cua ATP. Cdc gdc oxy l y do ndy tro- thdnh cac trung gian gdy hgi cho nhu md cdc tang, dac bidt cac te bdo cua phe nang phdi, te bao nhu md than, gan

Theo Edalmas va cong s y (2001), trong bdng s y giai phdng ra cdc gdc oxy t y do the hidn mgt trgng thdi stress oxy hod (oxydative, stress) 6' nhO'ng bdnh nhdn bdng ndng ed didn tfch bdng ttr 3 0 % DTCT tra Idn [2].

Nghidn cCru cua cdc tac gia n h u Nguyen TT, Cox C S vd cdng s y (1993) [8], Kumar R. vd cdng s y (1995) [6], Babik F. vd cdng sy (2001) [2],.,. deu cho I h l y d nhO-ng bdnh nhdn bdng ndng ndng dd cdc chat oxy cd tlnh ndng phan ung sinh hpc, ndng d d MDA tdng vd ndng d d men SOD, catalase deu giam . trong nhO'ng ngdy d i u sau bdng vd phyc hdi t u ngdy thiJp 15.

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TCYHTH&B so 2-2014 45

Sjnh lircrng enzym SOD t h i y c6 lidn quan d i n didn ttch bdng (DTB), tudi gid vd khi c6 bdng hd h i p . Djnh lugmg SOD vd TAS trong bdng ndng t h i y giam t h i p , ddc bidl Id s y gidm cd y nghTa cDa SOD. Ndng dd SOD g i i m t h i p ndi ldn s y huy ddng enzym ndy de c h ^ g ddi vdri cdc mCrc cao cua san p h i m oxy hda cdc c h i t t>do.

Dinh lugrng MDA trong bdng t h i y san p h i m OKy hda cdc c h i t bdo ndy tdng cao, c6 lidn quan chdt chd vd'i dd sdu, didn tdn thuang bdng vd b$nh ly bdng (sde, bdng hd h i p , n h i l m k h u i n , nhidm ddc bdng,...).

Demling R.H vd cdng s y (1995), dd nhdn I h l y cd mdi lidn hd giCra ndng dd gdc oxy t y do tdng cao trong mdu chudt gdy bdng thyc nghidm vdi tJ Id til' vong [5].

Cd mdi lidn hd chdt che gii>a enzym chdng oxy hod (SOD) vd'i s i n p h i m trung gian ctia qud trinh peroxy hod lipids.

Cetinkale vd cdng s y (1997) dd t i l n hdnh gdy bdng thyc nghidm cho thd, vd'i didn tich bdng 30% DTCT, sau dd l l l n hdnh xdt nghidm mdu bdnh nhdn Irong 3 ngdy d i u sau bdng, k i t q u i cho t h i y ndng dd MDA Id 1,75 ± 0,59 nmol/ml (so vd'i nhdm chd'ng khdng bdng Id 1,11 ± 0,37 nmol/ml. khdc bidl vd'i p < 0,02), cdn ndng dd SOD Id 15,85 ± 3,39 p/mi (nhdm chCrng khdng b d n g : 3 0 , 9 7 ± 4,19 p/ml, p < 0,0001) [4]. Mai Mgnh T u i n vd cdng s y (2007) nghidn cLru trdn bdnh nhi bdng ndng, cho t h i y tlnh trgng peroxy hod lipid xay ra ngay sau khi bj bdng, t h l hidn d ndng dd MDA cao n h i t trdn t i t ca cdc bdnh nhdn tir ngdy lhi> n h i t d i n ngdy thd- 3 sau bong (2,3

± 0,28 nmol/l). giam xudng d' nhu-ng ngdy thu 7 vd 14 sau bdng (p < 0,05) K i t qud nghidn ct>u cDng cho t h i y ndng dd men SOD giam mgnh n h i t ngdy 7 sau bdng, d i n ngdy t h u 14 vSn chua hdi phyc. Ndng dd men SOD gtam chi>ng td phdn dng oxy hod r i t mgnh, v( vdy lugmg enzym chdng oxy hod dd d u y c huy ddng vd sO' dyng n h i l u t u a n g ung [3]

Trong d i l u tri cdc bdnh nhdn bdng ndng, c i n p h l i dung phdi hg'p cdc c h i t chdng oxy

hod ngoai sinh. Matsuda T. vd edng s y (1993) dd dung vitamin C l i l u cao trong nhCrng gia dau sau bdng t h i y cd higu qua tdt [7]. Mdt sd tdc gid cdn s u dyng glutalhion dud'i dgng khi dung cd tdc dyng bao vg nhu md phdi vd ngdn s y tang sinh hydrogen peroxide do qud trinh tang oxy hod do cdc gdc Oxy t y do a l l bdo nhu md cdc p h i nang.

So tdc gia khdc de nghi s u dung vitamin C, p- carolen, selenium lectin de ldng cud'ng cho qud trinh t u bao vd cua c a t h l chdng cdc gdc oxy l y do trong tri lidu chu'a bdnh bdng [2].

Qun Zang (2008) dd cdng bd k i t qua thudn lgi trong dieu trj bgnh nhdn bong khi k i t hgp vd'i ligu phdp chdng oxy hod [9].

Hodng lidn giai dgc thang l u xa xua dd duac b i l l d i n cd tac dyng thanh nhidt, thai ddc Nghidn ci>u ciJa cac tdc gia WANG Li -jin, Xu Quiang (2000) [13], Zhao Bao-sheng vd CS (2009) [14],... d i u k h i n g djnh Hodng lidn giai ddc thang cd tdc dyng chdng vidm, khdng k h u i n kha tdt, d y a trdn ca c h l Idm giam s y hlnh thdnh cdc cytokin vidm, cdc gdc NO. Theo Song Jue, LU Tong vd CS (2010), Hodng lidn giai ddc thang cd tdc dyng chdng oxy hod mgnh trdn thyc nghidm bdng ndng, phg thudc vdo lieu luang vd thd'i gian s u dyng [10].

Trong nghidn cd-u ndy, de ddnh gid tdc dung cua che pham d i n kha ndng khdng gde l y do, chiing tdi s u dyng phuang phdp xdc djnh hoat dp cua enzym SOD (%). chi> khdng xdc dinh ndng do cua enzym nhu cdc nghidn ci>u cua cdc tdc gia khdc. Ket qua nghidn ci>u cua chung tdi cung cho t h i y , trdn thd thyc nghidm gdy bong, hogt dd SOD mdu tdng cao rd rdt sau bdng ngdy thu 3, thir 10 vd 17 sau bdng ndng so thdi d i l m Uud'c khi gdy bong thd. Tren bdnh nhdn bdng ndng, hogt dd SOD cung tdng cao kdo ddi sau t u ngdy thir 3 d i n ngdy 17 sau bdng, K l l q u i ndy cho I h l y mdt phan irng oxy hoa r i t mgnh dd xay ra d tho thyc nghidm gdy bdng ndng vd bdnh nhdn nghidn ci/u, Idm tdng hogt dd men SOD. Nghidn CLPU cung cho thay, cung mdt thd'i diem sau bdng thl hogt dd SOD d

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46 TCYHTH&B so 2-2014

nhdm dupe udng cao Idng VB09 cao han so vd'i nhdm chO-ng, khdc bidt cd y nghTa thdng kd vdi p<0,05 vd p<0,01. Dieu ndy chi>ng td, che phim VB09 cd tdc dung kich thich lam tdng hogt dd, tdng kha ndng chdng oxy hod cua enzym SOD.

Ddl vd'i xdt nghidm MDA, ket qua nghidn cii'u cQng eho thiy hdm luyng MDA ldng cao d cdc thdi dilm ngdy thu 3, thir 10 vd thu-17 sau bdng. Cung mdt thd'i diem sau bdng tht hdm luyng MDA d' nhdm duyc udng cao long VB09 ludn thap han so vd'i nhdm chu'ng, khdc bidt cd y nghTa thdng kd vd'i p<0,05 vd p<0,01. Dieu ndy chting td, che pham VB09 cd tdc dgng Idm giam qud trinh hinh thdnh cdc gdc oxy ty do, giam qud trinh oxy hod chat bdo (san phim cudi cOng Id MDA), cd tac dgng bao vd ca t h l chdng oxy hod.

* £>6i vai ning do axit uric huyit titong Kit qua xdt nghidm ndng dd axit uric huylt tuang cua BN bdng ndng cho thay:

ndng dd axit uric mdu tdng cao nhat vdo thd'i dilm ngdy thO-10 sau bdng d' ca hai nhdm. O cOng thdi dilm N2, N3: ndng dd axil uric nhdm chCrng ludn cao han nhdm nghidn ci>u (p < 0,05) (bang 3.8). Theo Becker B.F (1993), Glanlzounis GK vd CS (2005), ndng dd axit uric trong mdu tdng cao Id mdt dau hidu cOa stress oxy hda, ddng thd'i cd the ddng vai trd liem ndng nhu mdt chdt anlioxydant [1], [16]. Dieu dd chung td qud trinh phan ung oxy hda d nhdm chCrng cao han so vd'i nhdm Nghien ciru, cao Idng VB09 cd tdc dung antioxidant.

Kit qua nghidn cuu ciJa chOng tdi Id phCi hpp vd'i kit qua nghien cuu cua nhieu tdc gia khdc. Wooliscroff F.O vd cdng sy (1990) [12]

dd chirng minh mdt edch hien nhidn vd sy sinh san ra cdc gdc oxy ty do a ngudi bj bong vdi didn tich bdng td 20% DTCT trd' Idn Theo Edalmas va cdng sy (2001), trong bdng sy giai phdng ra cdc gde oxy ty do the hidn mdt trgng thdi stress oxy hod (oxydative stress) d"

nhu'ng bgnh nhdn trong ndng cd didn lich bdng lu 30% DTCT tra tdn [2] Theo Song

Jue, LU Tong vd CS (2010), Hodng lien giSi dpc thang cd tac dyng chdng oxy hod mgnh trdn thyc nghidm bong ndng, phy Ihudc vdd lilu lup'ng vd thd'i gian sO* dung [10].

Theo chOng toi, che pharp VB09 cd tdc dgng anlioxydant vi:

Trong thdnh phin cao Idng VB09 c6 chO'a flavonoid. Id chit cd kha ndng dgn gdc oxy ty do, d'c chl sy tgo, thanh MDA, do dd cd tdc dyng chdng oxy hda manh [15].

Thdnh phan alcaloid (md chu yeu Id berberin) chira trong c h l phim cd tdc dyng khdng khuin, chdng vidm. Khi diiing dudng udng thudc cd tdc dgng gdp phin tdi ldp cdn bdng khuin chl trong dud'ng tidu hoa, tdng tdi tgo nidm mgc dg ddy, giSm sy tham l|u vi khuin. ddc td ndi vi khuin vdo mdu, do d6 Idm giam qud trinh tgo gdc oxy ty do trong mdu. Ddng thd'i, berberin cdn i>c chl NADPH oxidgse, cdng cd ldc dyng'Idm gigm qud trinh tgo gdc ty do cua dgi thyc bdo.

Theo WANG Li -jin vd CS (2000) [13], Zhao Bao-sheng vd CS (2009) [14], .H|.GDT cdn dc chl t l bdo san sinh ra lL-1 vd i>c chl san sinh NO lai phiic mgc chudt, Idm giim qud trinh san xult gdc ty do dgng peroxynitrite. Tdc dyng khdng khuaii, giiip ldp Igi cdn bdng khuin chi d' du&ng lidu hda thd

& BN bdng ndng cua VB09 cOng ly giai tridu chu'ng ig chay giam rd ret d nhdm Nghidn ciru so vdi nhdm chirng (p < 0,05).

Thyc t l kit qua nghien ciJu dd khdng djnh, cao Idng VB09 c6 tdc dung antioxidant 4.2. Cac tdc dung lam sdng khdc

* 7ac dyng bao v$ ti bao gan

Gan Id mdt trong nhO'ng tgng quan trpng

cua ca the, chju anh hudng cua cdc gdc oxy

ty do nhilu nhit. Dud'i tdc dyng cua cdc gic

oxy ty do, mdng te bdo gan se b| tdn thuang,

Idm ton hgi din phin ndi bdo, giai phdng mOt

lupng Id'n men gan vdo mdu. Trong thdnh

phin VB09 cd chira flavonoid c6 tdc dyng

giiip te bdo gan chdng Igi tdc nhdn oxy hda.

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TCYHTH&B so 2-2014 47

K i t qua nghidn c i r u dia chung tdi cho t h i y , ndng dd men gan cr nhdm Nghidn ciru cd xu, hudng t h i p han so vd'i nhdm Chung, tuy nhidn khdc bi$t chua cd y nghla thdng kd vd'i p > 0,05, t u a n g d u a n g vdi k l l qua nghidn ci>u cua n h i l u tdc gia khdc. Ly do Id tren BN bdng ndng vd r i t ndng, ngodi tdc hgi cua cde gdc oxy t y do, t l bdo gan ndi ridng vd todn ca t h l ndi chung cdn chju anh h u a n g cua nhilu y l u td khdc nhu ddc td bdng, ddc td vi khuin,£dc cytokine, cdc thudc d i l u tn,... Mdt khdc. sd luyng BN nghidn c u u chua du Idn, c i n thiet phai cd thdm nghidn ciru vd'i sd luyng BN ldn han, t h u thdm n h i l u lieu thudc khde nhau md'i cd t h l nhdn xdt mdt cdeh chlnh xdc.

* Tic dyng kich thich lieh vet thuxmg K l l qud nghidn ciru cua chung tdi cho thiy, thd'i gian t i l n v l t t h u a n g dd II, lit vd thd'i gian hlnh thdnh td chi>c hgt dgp sau cdt hogi ti> d nhdm nghidn cO'u c6 xu huOng t h i p han nhdm chirng.

C h l p h i m VB09 cd tdc dyng thdc d i y qud trinh l l l n v l t t h u a n g vl trong thdnh p h i n cOa c h l p h i m cd chira flavonoid. Theo Phan Todn T h i n g vd CS (1998) [15], flavonoid cd tdc dyng kich thfch ldng trudng l l bdo flbrobiasts, ddy Id t l bdo quan trpng nhat cua pha tdng sinh, ngodi ra, fibroblasts cdn giiip co rill, thu hgp v l t thuang, thiic d i y qud trinh llln v l t thuong. Mdt khdc, chlnh tdc dyng khdng gde l y do cua che pham cOng gdp p h i n thiic d i y qud trinh l i l n v l t thuang.

Nh&ng nghidn cd-u sdu ve tgi c h l tdn thuong bdng, cdc v l t t h u a n g khd l i l n vd mgn tlnh cho I h l y , cd t h l gdy rg qud trinh san sinh vd tich IQy cdc gdc oxy t y do tgi v l l thuang. Gdc ndy r i t dde eho md, Idm tdn thuang le bdo ndi mgc mgch mdu, tan vd' bgch c l u , . . . cdng tdm v i t thuang lan rdng vd ehdm qud trinh l l l n v l t thuang. Do dd, r i t c i n cd nhO'ng nghidn ciru di sdu nghidn cu'u v l tdc dgng cua VB09 vd nhieu c h l pham cd ldc dyng khdng gdc t y do trong d i l u In l i l n v l t thuang.

K i t qua nghidn ciru cung cho thiy, didn b i l n bdnh iy cua BN nghien ciru Id r i t ndng n l d ca hai nhdm. Tuy nhidn, s y khde bidt giu'a hai nhdm Id chua cd gid tri thdng kd (p > 0,05).

Theo chiing tdi, cao long VB09 khi s u dyng tren idm sdng cd tdc dung khdng gdc t y do, cai thidn cdc tridu chung, d i l n bien, k i t qua d i l u tri BN. Tuy nhidn, do ddi tupng BN dupe Chung tdi chpn vdo nghien ci>u deu Id nhCrng BN bdng ndng vd r i t ngng, c6 nhu t h l cdc b i l u hidn cua nhidm khuan n h i l m ddc md'i rd rdt. & nhOng BN ndy, s y dap irng cua c a t h l mang tinh hd thdng (SIRS). SIRS, n h i l m k h u i n hd thdng. rdi logn chirc ndng da tgng, suy dg phu tang Id mdt qud trinh tidn lyc.

Bieu hidn Idm sdng, cdn Idm sdng cua BN t)dng ndng thd'i ky ndy phan dnh nhieu yeu td, do n h i l u y l u td chi phdi nhu ddc td bdng, ddc td vi k h u i n , ede cytokin, gde oxy t y do,...

ddi hdi phai cd c h i l n l u y c d i l u trj todn didn, gdm d i l u trj theo c a che bdnh sinh, d i l u trj tridu chirng, d y phdng vd d i l u trj b i l n chCrng, cd nhu vdy md'i cd the ndng cao c h l l lupng dieu trj bdnh nhdn bdng ndng.

S. K £ T LUAN

C h l p h i m cao Idng VB09 dCing dud'ng udng cO tdc dyng hd try d i l u trj bdnh nhdn bdng ndng, thdng qua cdc tdc dgng:

Tdc dyng chdng oxy hod (antioxidant):

Si> dyng VB09 Idm tdng hogt dd cOa men SOD, ldm giam hinh Ihdnh gdc l u do, giam qud trinh oxy hod chat bdo tgo thdnh MDA vd Idm giam ndng dd axit uric trong h u y l t luong a nhdm nghidn CLFU so vOi nhdm chirng.

khdc bidl cd y nghTa thdng kd vdi p<0,05 vd p<0,01

- Tdc dyng bao vd l l bdo gan: Khi s u dyng trdn bgnh nhdn nghidn cu'u, ndng dd men SGPT, SGOT d nhdm nghidn cCru cd xu hudng t h i p han d nhdm chCrng.

- Tdc dyng kIch thich l i l n v l l thuang: thCri gian l i l n vet thuang dd H, HI vd thd'i gian cd td chirc hgt dgp sau cdt hogi tO d* nhdm nghidn ciru ed xu hudng thap han d nhdm chimg.

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48 TCYHTH&B s6 2-2014

TAI LIEU THAM KHAO

1 Nguyin Hiru Chin va cpng sy (1999), 'Goc ti/

do va sv chfing oxy hoa trong sinh ly hoc', M^t so van ds hoa sinh hl$n d^f, NXB khoa h^c ky thu|t, tr.195-271

2 Lfi Thl Trung (2003), Bong - Nhifng kien thtfc chuyen ngAnh, NXB Y hpc. Hh N^i.

3. Mai M^nh Tuin vk cpng s y (2007), "Nhin x6t ve thay doi tinh Ir^ng oxy hoa trdn l}dnh nhdn nhi bong rgng', T^p chiYhtfc tfiam h09 & Bong, st 2, tr. 33-38.

4 Cetinkale 0. et al (1997), 'Evaluation of lipid peroxidation and total antioxidant status tn plasma of rats following theimal injury". Bums, vol. 25. No 2,pp 114-6.

5. Demling R. et al (1995), "Increased lipid peroxidation and decreased antioxidant activity correspond with death after smoke exposure in the rat", JBum Care Rehabil; 16:104-10.

6. Kumar R. et al (1995), 'Serum lipid peroxide and other enzym levels of patients suffering from thermal injury", Burns; 21 96-7.

7. Matsuda T. et al (1993), 'The effects of high -dose vitamin C therapy on postburn lipid peroxidation", J Bum Care Rehabtt; 14: 624-9.

8. Nguyen TT, Cox CS et al (1993), "Free radical activity and loss of plasma antioxydants, vitamin' E and sulftiydryl groups in patients with burns', J Bum Care Rehabil; 14:602-9.

9. Qun Zang (2008), "Cardiac mitochondrial damage and loss of ROS defense after bum injury the

beneficial efects of antioxidants therapy', NaSm^

Institute of General Medical Sciences Grant , 10. SONG Jue et al (2010), "A serum pharmacological

study on anlioxidation effects- of Huanglian Jiedu Tang". Chinese Joumal of ExperimentalTradiSonal Medical Formule.-Voi. 16. No. 4; pp. 118-22.

11. Sun Y. et al (1988), "A simple method for dinical assay of superoxide dismutase", Clin Chem; 34:

497-500

12. Wooliscroff J.O et al (1990), 'Metabolic alterations in bum patients: detection of adenosin triphosphate degradation" products and lipid peroxides", Sums; 16:92-6

13. Wang U -jin, Xu Quiang (2000), 'Mechanism of anti -flammatory action of Huanglian , Jiedu Decoction A Traditional Chinese Prdscrijstion", China Journal of Chinese Materia Medlca, Vol. 25, No. 8; pp. 496-9.

14. Zhao Bao-sheng et aL(2009). 'The experiinetal study of Huangllanjiedu Decoction on Relie\nng Fever and Anti -inflamatory effects", Chinese Joumal of Experimental Traditional Medical Formule, Vol. 15, No. 11; pp. 55-7.

15. P.TJhang et al (2001), 'Antioxidant effect of the extract from the leaves of Chromolaena odorota on human dermal fibroblasts and epidermal keratinocytes against hydrogen peroxide and hypoxanthine - xanlhin oxidase induce damage' Bums, 27, pp.319-27.

16 Becker BF (June 1993), 'Towards the physiological function of uric acid". Free Radical Biology & Medicine 14(6): 615-31.