摘要
目的：分析重度脓毒症患者的细胞免疫状态，并研究α1胸腺肽对免疫调节治疗的影响。方法：选取2010年2月～2011年2月我院重度脓毒症患者135例，监测血清单核细胞人白细胞DR抗原（HLA—DR）、T淋巴细胞亚群绝对计数的动态变化；研究取CD2T淋巴细胞绝对计数〈410cells／μl的患者，并分为治疗组和对照组．治疗组再按CD4＋T淋巴细胞绝对计数进行亚组分析。治疗组皮下注射α1胸腺肽1．6mg／d，连续7d，同时给予经典SSC治疗：对照组给予经典SSC治疗。观察患者治疗前及治疗后3、7d上述免疫指标。结果：85例重度脓毒症患者HLA—DR、CD3^＋、CD4^＋和CD8^＋T淋巴细胞明显降低，治疗组治疗后7dHLA—DR、CD3^＋、CD4^＋和CD8^＋均明显增高，且7dHLA—DR、CD3^＋、和CD8^＋较3dHLA—DR、CD3^＋和CD8^＋增高，差异有统计学意义（P〈0．05或P〈0．01）。与对照组同期比较。治疗组治疗后3dCD3^＋、7dHLA—DR、CD4^＋和CD8^＋均增高，7dCD3^＋则明显升高，差异有统计学意义（P〈0．05或P〈0．01），而CD4^＋／CD8^＋比值无明显变化。治疗组亚组分析显示轻中度免疫低下患者单核细胞CD14^＋HLA—DR和T淋巴细胞计数短期内均呈上升趋势，重度免疫低下患者仅治疗后7dCD3^＋治疗前增高（P〈0．05）。结论：重度脓毒症患者存在细胞免疫抑制；α1胸腺肽具有免疫增强的作用，且对轻中度免疫低下效果更好，重度免疫低下持续治疗也能获益。
Objective： To explore the cellular immunity state in the patients with severe sepsis and influences of immune- modulation therapy with Thymosin α1. Methods： 135 patients with severe sepsis in our hospital from February 2010 to February 2011 were enrolled. The trends of serum CD14^＋ monocyte HLA-DR levels, the absolute counting of T lymphoeytes subpopulation were monitored. And the patients with severe sepsis were randomly divided into two groups by the absolute counting of CD4CF lymphoeytes subpopulation〈410 cells/μl. The patients in control group were treated with classical SSC therapy, those in treatment group were treated with Thymosin α1, 1.6 mg subcutaneous injection per day, continued 7 days and classical SSC therapy. Levels of above immune indexes were detected before treatment and after 3 days and 7 days of treatment. Results： Levels of serum HLA-DR, CD3^＋, CD4^＋, CD8^ T lymphocyte were significantly decreased in 85 patients with severe sepsis. Levels of serum HLA-DR, CD3^＋, CD4^＋, CD8^＋ T lymphocyte were increased significantly after 7 days treatment in treatment group. These parameters were higher after 7 days than after 3 days （P〈0.05 or P〈0.01）. Compared with the variables at the same period in the control group, CD3^＋ T lymphocytes after 3 days and HLA-DR, CD3^＋, CD4^＋, CD8^＋ after 7 days were increased significantly treatment in treatment group, but differences between ratio of CD4^＋/CD8^＋ were not statistically significant. Subgroup-analysis showed that there was a increasing tendency in short term for slight or midrange immune-depression patients in treatment group. Levels of serum CD3^＋ were only increased after 7 days for severe immune- depression patients （P〈0.05）. Conclusion： The cellular immune-depression is existed in patients with severe sepsis. Thymosin on can increase cellular immunity. There are more effective in slight or midrange immune-depression, and severe immune-depression patients also benefit from continuous treatment.
出处
《中国医药导报》
CAS
2011年第31期54-56,59,共4页
China Medical Herald
关键词
重度脓毒症
Α1胸腺肽
细胞免疫
随机对照试验
Severe sepsis
Thymosin α1
Cellular immunity
Randomized controlled trials
