胸腺肽α1在重症医院获得性肺炎中的应用

Application of thymosin alpha1 to the patients with severe hospital acquired pneumonia

目的探讨胸腺肽α1治疗对重症监护病房(ICU)内重症医院获得性肺炎(SHAP)患者CD14+单核细胞人类白细胞抗原DR(HLA-DR)、T细胞亚群和自然杀伤(NK)细胞的影响及其临床意义。方法ICU内38例符合SHAP和脓毒症标准且CD14+单核细胞HLA-DR<30%的患者纳入本研究,随机分为治疗组(n=21)和对照组(n=17)。治疗组在SHAP常规治疗基础上给予1.6 mg胸腺肽α1皮下注射,2次/d,持续1周。对照组仅给予SHAP常规治疗。在胸腺肽α1治疗前及结束治疗时分别测量CD14+单核细胞HLA-DR、T细胞亚群和NK细胞的水平,并观察患者的ICU住院时间和机械通气时间及生存状况。结果治疗组治疗后CD14+单核细胞HLA-DR、CD4+细胞及CD4+/CD8+比值明显上升,对照组治疗后无改善。但两组ICU住院死亡率无显著差异。存活者和死亡者间的CD14+单核细胞HLA-DR有显著性差异,而CD4+细胞、NK细胞及CD4+/CD8+比值无显著性差异。治疗组中存活者的ICU住院时间和机械通气时间均比对照组中的存活者明显缩短。结论胸腺肽α1能提高ICU内SHAP患者CD14+单核细胞HLA-DR、CD4+细胞及CD4+/CD8+比值,且缩短了存活者的ICU住院时间和机械通气时间,但未能降低ICU住院死亡率。

Objective To investigate the effects of thymosin alphal on CD14＋ monocyte human leukocyte antigen DR（ HLA - DR）, T lymphocytes subpopulation and NK cell and clinical significance in the patients with severe hospital acquired pneumonia（SHAP） in intensive care unit（ICU）. Methods A total of 38 patients with SHAP and sepsis were randomly divided into 2 groups： the treatment group（n=21） and the control group（n=17）, The level of CD14＋ monocyte HLA-DR of each patient in the study must be lower than 30%. All the patients received conventional therapy for SHAP. The treatment group received thymosin alphal 1.6 mg by subcutaneous injection q12h for a week on the basis of conventional therapy for SHAP. The therapeutic effect against immunosuppression was evaluated by measuring the level of CD14＋ monocyte HLA-DR, T lymphocytes subpopalation and NK cell at admission and immediately after treatment. ICU mortality, duration of ICU stay and mechanical ventilation were observed. Results The level of CD14＋ monocyte HLA-DR, CD4＋ cell and CD4＋/CD8＋ ratio increased significantly after treatment in the treatment group. These parameters were not improved in the control group, but there was no significant difference in ICU mortality between the two groups. There was significant difference in the level of CD14＋ monocyte HLA-DR and no significant difference in the level of T lymphocytes subpopalation and NK cell between the survivors and the nonsurvivors. The duration of ICU stay and mechanical ventilation in survivors of treatment group decreased significantly compared with those in survivors of control group. Conclusions Thymosin alphal can increase the level of CD14＋ monocyte HLA-DR, CD4＋ cell and CD4＋/CD8＋ ratio and is an effective method for improving immunosuppression in patients with SHAP and sepsis. Thymosin alphal can also shorten the duration of ICU stay and mechanical ventilation, but did not decrease the ICU mortality of treatment group.