摘要
目的研究小剂量糖皮质激素（glucocorticoid，GC）对重症患者糖皮质激素受体（glucocorticoid receptor，GR）及细胞免疫功能的影响。方法收集2007年3月-2009年3月ICU重症患者40例，根据有无应用GC治疗分为GC组和非GC组，在GC治疗后1，7，10d收集血液标本，检测外周血中单核白细胞（mononuclear leukocytes，MNL）和多核白细胞（polymorphonuclear leukocytes，PML）上GR的结合容量、T淋巴细胞CD4／CD8比值。GC使用方法：氢化可的松100mg，每8h／次静脉注射。结果外周血MNL的GR结合容量第1，7天GC组和非GC组间差异无统计学意义。GC组第1天GR结合容量较低，第7天更低（P〈0．05）；非GC组第1天GR结合容量偏低，但第7天GR结合容量显著提高（P〈0．05）。外周血PML上GR的结合容量变化趋势与MNL相似。CD4／CD8比值第1天GC组和非GC组间比较差异无统计学意义；第10天CD4／CD8比值非GC组明显高于GC组（P〈0．05）；GC组CD4／CD8比值第10天略降低，与第1天比较差异无统计学意义；非GC组第10天CD4／CD8比值比第1天显著提高（P〈0．05）。结论小剂量GC对外周血白细胞GR结合容量有一定负反馈调节作用，对细胞免疫功能有一定的抑制作用。
Objective To study the effects of small-dose glucocorticoid （GC） on glucocorticoid receptor （GR） and cellular immune function in critical patients. Methods Forty ICU critical patients admitted in Shanghai Changzheng Hospital from March 2007 to March 2009 were enrolled in the study and were divided into GC group and non-GC group according to the use or absence of GC. Blood samples were collected at days 1, 7 and 10 after GC treatment to detect GR binding affinity of mononuclear leukocytes （MNLs） and polymorphonuclear leukocytes （PMLs） in the peripheral blood and the CIM/CD8 ratio in the T lymphocytes. The method of GC use was that the hydrocortisone was given intravenously at a dose of 100 mg every eight hours. Results GR binding capacity of MNLs at day 1 and 7 showed no statistical difference between the GC and non-GC groups. GR binding capacity of MNLs in the GC group was lower at day 1 and was much lower at day 7 （P 〈0.05）. However, in the non-GC group, it was lower at day 1, but showed significant improvement at day 7 （P 〈 0.05 ）. The change of GR binding capacity of PMLs was sim- ilar to that of MNLs. There was no significant difference of CD4/CD8 ratio between the GC and non-GC group at day 1. The ratio of CIM/CD8 in the non-GC group was significantly higher than that in the GC group at day 10 （P 〈 0.05）. CIM/CD8 ratio in the GC group showed a slight reduction at day 10, with no significant difference from that at day 1. While, the non-GC group showed a significant increase of CD4/ CD8 ratio at day 10 as compared with that at day 1 （P 〈 0.05）. Conclusion Low-dose GC plays some role in the negative feedback regulation of GR binding capacity of peripheral blood leukocytes and in the in- hibition of cellular immune function.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2012年第10期894-896,共3页
Chinese Journal of Trauma
