腹部重症脓毒症老年患者术后免疫球蛋白及补体的变化

Dynamic Changes of Immunoglobulin and Complement in Elderly Postoperative Patients with Severe Sepsis

目的术创伤、脓毒症均可通过多种途径影响机体的免疫功能,本文通过对腹部重症脓毒症患者机体免疫指标(免疫球蛋白及补体 IgA、IgG、IgM、C3、C4,为重症脓毒症患者免疫治疗及各免疫指标的变化对严重脓毒症患者预后的影响提供参考。方法将20例腹部无明显感染的患者、15例腹部脓毒症患者不伴器官功能障碍、12例腹部严重脓毒症及脓毒性休克患者分为 A、B、C组,A、B、C 组术后第1、3、7天,各抽取外周静脉血5ml 于普通试管,测定免疫球蛋白及补体(IgA、IgG、IgM、C3、C4)。同时记录生命体征的变化和预后转归。结果 A 组与术前比较,免疫球蛋白在第1天 IgA、IgM、Igc,C3、C4均下降,IgA、IgM 与术前比较,差异有显著性(P<0.05),而补体 C3在第1天明显下降,与术前、术后第7天相比差异均具有显著性(P<0.05),C4下降不明显,无统计学意义(P>0.05),A、B 两组术后第1、3、7天 IgA、IgG、IgM、C3、C4均无显著统计学差异(P>0.05),第1、3、7天 C 组 IgA、IgM、IgG、C3、C4均低,与 A、B 两组相比较明显降低,具有统计学意义(P<0.05)。结论手术创伤对免疫球蛋白影响不大。对于术后重症脓毒症及脓毒性休克患者 IgA、IgM、IgG,C3、C4明显降低,且随病情恶化,持续在较低水平。

Objective To investigate the change of the immune function（immunoglobulin： IgA,IgG,IgM, the complement -3,4） in severe sepsis patients and its effect on prognosis of patients. To provide reference for the immune treatment. Methods 58 cases were divided into groups A,group B and group C. Group A included 20 patients without obvious infection in their abdomens. Group B included 20 patients with serious sepsis, but without organ dysfunction. Group C included 18 patients with serious sepsis and septic shock. 5ml peripheral blood was collected preoperation and 1,3,7days after operation. The immunoglobulin IgA,IgG,IgM and complement-3,4 were measured. Vital sign and prognosis were recorded. Resuits Compared with the preoperative immune functions,there was significant difference among IgA,IgM,IgG complement- 3,4 in the first day in group A postoperative, but from then on, IgA, IgM, IgG and complement-3,4 go up obviously to preoperative level in the postoperative seventh day. Compared with the level of complement-3,4 IgA, IgM, IgG in preoperation and the postoperation seventh day,there was not significant difference （ P 〉 0. 05 ）. IgA, IgG, IgM, complement-3,4 showed no significant difference in the postoperation first, third and seventh day between group A and group B （ P 〉 0. 05 ）. In the first,third and seventh day,the levels of IgA,IgG,IgM and complement-3,4 in group C were lower than in group A,B and there was significant difference（ P 〈 0. 05 ）. Conclusion Operation has less effect on immunoglobulin, but the levels of IgA,IgG, IgM and complement-3,4 in severe sepsis and septic shock patients were consistently low.