胸腺肽-α1对脓毒性休克患者细胞免疫功能的影响

Effects of thymosin - α1 on cell immunity function in patients with septic shock

目的探讨胸腺肽-α1对脓毒性休克患者细胞免疫功能的影响及其对病情转归的干预作用。方法将重症加强治疗病房（ICU）治疗的42例脓毒性休克、且急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分在15～25分之间的患者纳入本研究，同时排除近3个月使用过免疫制剂、激素及肿瘤、器官移植和伴有慢性疾病终末期患者。随机分为治疗组（n=21）和对照组（n=21），两组患者入院后均给予广谱抗生素治疗，治疗组在上述基础上皮下注射1．6mg胸腺肽-α1，每日2次，持续1周。抽取全部患者治疗1、3和7d时的静脉血，采用微量全血直标法分别检测T细胞亚群和自然杀伤（NK）细胞水平，并观察患者的体温、ICU住院时间、机械通气时间、28d病死率及总住院费用。结果治疗组经治疗后，CD3＋、CD4＋、NK细胞及CD4＋／CD8＋比值均明显上升（P均〈0.01）。体温下降时间、ICU住院时间、机械通气时间、总住院费用和28d病死率均较对照组明显下降（P〈0.01）。结论胸腺肽-α1能提高脓毒性休克患者的细胞免疫功能，从而改善症状，缩短ICU住院时间和机械通气时间，降低28d病死率。细胞免疫功能是脓毒性休克患者抢救成功与否的重要因素之一。

Objective To investigate the effects of thymosin -α1 on cell immunity tunction anti outcome in the patients with septic shock. Methods Forty -two patients with septic shock in the department of intensive care unit （ICU） and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） scores between 15 and 25. Patients with tumor, organ transplantation, chronic end- stage diseases and those who had used immunity inhibitor in recent 3 months or hormones were excluded. The patients were randomized into two groups： thymosin group （n ： 21） and control group （n= 21）. Patients in thymosin group were treated with thymosin- α1 1.6 mg by subcutaneous injection twice daily for 1 week in addition to the administration of broad - spectrum antibiotics to all patients. The levels of T lymphocyte subtype and natural killer （NK） cell were determined on the day 1, 3 and 7. At the same time, temperature, ICU stay days and duration of artificial ventilation, 28- day mortality and the expenses of hospitalization were recorded. Results In the thymosin group, the levels of CD3＋, CD4＋, NK cells and the ratio of CD4＋/CD8＋ were increased obviously （all P〈0.01）. The mean afebrile period, stay days in ICU, duration of mechanical ventilation and hospital expenses as well as 28 -day mortality were decreased obviously compared with those of control group （all P〈0.01）. Conclusion Thymosin- α1 can improve cell immunity function in the patients with septic shock. The cell immunity function is one of the main factors in influencing the prognosis of septic shock.