詹燕春,徐玫,徐娅,刘一诚
ZHAN Yanchun,XU Mei,XU Ya,LIU Yicheng

• 1:彭州市中医医院重症医学科

摘要(Abstract)：

目的:观察胸腺肽α1联合血必净对脓毒症患者免疫功能和炎症水平的影响。方法:选取重症加强护理病房(ICU)收治的脓毒症患者96例,分为研究组患者52例(给予胸腺肽α1联合血必净治疗)与对照组患者44例(给予胸腺肽α1治疗);采集所有患者治疗前和治疗后第7天时外周静脉血,采用流式细胞仪检测CD3~+、CD4~+T细胞,自然杀伤(NK)细胞计数及CD4~+/CD8~+比值,采用化学发光法检测血清降钙素原(PCT),采用酶联免疫吸附法检测C反应蛋白(CRP)和白细胞介素-6(IL-6)水平;采用急性生理与慢性健康评分(APACHEⅡ)和全身感染相关性器官功能衰竭评分(SOFA)评价患者治疗前和治疗后第7天时病情的严重程度,并收集患者ICU住院时间、住院期间多器官功能障碍综合征(MODS)发生情况及住院28 d内病死情况。结果:2组患者外周血CD3~+、CD4~+T细胞,NK细胞计数及CD4~+/CD8~+T细胞比值治疗后均较治疗前升高,且治疗后研究组患者均高于对照组(P<0.05);2组患者血清PCT、CRP、IL-6水平治疗后均较治疗前降低,且治疗后研究组患者均低于对照组(P<0.05);2组患者APACHEⅡ、SOFA评分治疗后均低于治疗前,且治疗后研究组患者均低于对照组(P<0.05);患者治疗前、后外周血CD3~+、CD4~+T细胞,NK细胞计数及CD4~+/CD8~+比值分别与APACHEⅡ评分、SOFA评分呈负相关(P<0.05);研究组患者ICU住院时间、MODS发生率及28 d病死率均低于对照组(P<0.05)。结论:与单纯给予胸腺肽α1辅助治疗相比,胸腺肽α1联合血必净治疗可以更好地调节脓毒症患者免疫功能、减轻炎性水平、保护器官功能及改善患者预后。
Objective: To observe the effects of thymosin α1 combined with Xuebijing on immune function and inflammation levels of patients with sepsis. Methods: The clinical data of 96 patients with sepsis from ICU were collected, and the patients were divided into study group(52 cases) and control group(44 cases). Control group was given thymosin α1 on the basis of routine treatment, and study group was given Xuebijing on the basis of control group. The T cell CD3~+, CD4~+, CD4~+/CD8~+ ratio and natural killer cell(NK cell), serum procalcitonin(PCT), C-reactive protein(CRP) and interleukin-6(IL-6) were detected in the two groups before treatment and on the 7~(th) day after treatment, and the acute physiology and chronic health evaluation(APACHEII) and systemic infection related organ failure score(SOFA) were used to evaluate the severity of disease, and the hospitalization data such as ICU stay, incidence rate of multiple organ dysfunction syndrome(MODS) and 28 d mortality rate were collected. Results: On the 7~(th) day after treatment, the levels of CD3~+, CD4~+, CD4~+/CD8~+ and NK and scores of APACHEII and SOFA in the two groups were increased compared with those before treatment(P<0.05) while the levels of serum PCT, CRP and IL-6 were decreased compared with those before treatment(P<0.05). Compared with control group, the levels of CD3~+, CD4~+, CD4~+/CD8~+ and NK in study group were significantly higher than those in control group(P<0.05) while the levels of PCT, CRP and IL-6 and scores of APACHEII and SOFA were significantly lower than those in control group(P<0.05). Pearson correlation coefficient showed that the levels of CD3~+, CD4~+, NK and CD4~+/CD8~+ were negatively correlated with APACHE II score and SOFA score before and after treatment(P<0.05). The ICU stay, incidence rate of MODS and 28 d mortality rate in study group were significantly lower than those in control group(P<0.05). Conclusions: Combined with Xuebijing on the basis of thymosin α1 for patients with sepsis can better regulate the immune function, reduce the inflammation levels, protect organ function and improve prognosis.

关键词(KeyWords)： 脓毒症;炎症;血必净;免疫功能;病死率;胸腺肽α1
sepsis;inflammation;Xuebijing;immune function;mortality rate;thymosin α1

Abstract:

Keywords:

基金项目(Foundation): 四川省干部保健科研课题(川干研2015-504)

作者(Author): 詹燕春,徐玫,徐娅,刘一诚
ZHAN Yanchun,XU Mei,XU Ya,LIU Yicheng

DOI: 10.19367/j.cnki.1000-2707.2020.01.020

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