免疫调理治疗改善脓毒症炎症因子、体液和细胞免疫以及预后的作用

Immunomodulation therapy improves inflammatory cytokines,humoral immunity and cellular immunity in septic patients

目的研究免疫调理治疗改善脓毒症炎症因子、体液和细胞免疫功能以及预后的作用。方法前瞻性分析70例符合脓毒症患者,随机分成对照组和治疗组,对照组接受常规治疗,治疗组行常规治疗联合使用蛋白酶抑制剂和胸腺肽α1治疗(常规治疗+免疫调理),免疫调理疗程为7 d,分别观察治疗前和治疗后第1、3、7天相关免疫学指标,并收集临床资料和预后情况。结果脓毒症患者免疫调理炎症因子的分析,治疗组TNFα-降低比对照组明显,两组比较差异有统计学意义(P<0.05);治疗组IL-8与对照组比较,差异无统计学意义(P>0.05);治疗组IL-10升高比对照组明显,两组比较差异有统计学意义(P<0.05)。脓毒症患者免疫调理体液免疫的分析,治疗组的IgG水平比对照组有所提高,两组差异有统计学意义(P<0.05);治疗组补体C3和补体C4水平与对照组比较,差异均无统计学意义(P>0.05)。脓毒症患者免疫调理细胞免疫的分析,治疗组CD4+T淋巴细胞比对照组明显升高,两组差异有统计学意义(P<0.05)。住院期间,对照组死亡20例,治疗组死亡13例,两组比较差异有统计学意义(P<0.05)。结论脓毒症患者免疫调理可以明显降低促炎因子TNFα-水平,升高抗炎因子IL-10水平,轻度提高体液免疫中IgG水平,升高细胞免疫中CD4+T淋巴细胞数,增加脓毒症患者的住院生存率。

Objective To study and observe immunomodulation therapy how to improve inflammatory cytokines,humoral immunity and cellular immunity and prognosis in septic patients.Methods Prospective analysis seventy patients conform to the enrolled standard.It is divided into two groups at random.One is control group with regular therapy,the therapy group with Ulinastatin plus Thymosin-α1 in a week.Observe the immune index before and after therapy in the 0,1 st,3 rd,7 th day,including the continue change of clinical and survival data.Results TNF-α had more significant decrease in therapy group than that in control group,P〈0.05.There was no significant difference in IL-8 of two groups,P〉0.05.IL-10 had more significant increase in therapy group than that in control group,P〈0.05.IgG had more significant increase in therapy group than that in control group,P〈0.05.C3 and C4 had no significant different in two groups,P〉0.05.CD＋4 T lymphocyte had more significant increase in therapy group t han that in control group,P〈0.05.During hospitalization,twenty patients died in the control group and thirteen patients died in the therapy group.It is significant difference between two groups,P〈0.05.Conclusions Immunomodulation therapy in septic patients can decrease TNF-α and increase IL-10.Immunomodulation therapy in septic patients can increase IgG level slightly and raise CD＋4 T lymphocyte counting and improves survival during hospitalization.