高龄老年肺部感染患者免疫功能变化与免疫调节治疗临床研究

Comparative study of thymosin α1 on immunoregulation effect in aged patients with lung infection

目的观察了解高龄老年肺部感染患者细胞免疫与体液免疫功能变化,探讨胸腺肽α1(Tα1)免疫调节辅助抗感染治疗免疫功能改善的临床疗效。方法入选≥80岁高龄老年肺部感染患者68例,随机分为试验组(Tα1组)和对照组,每组各34例。Tα1组使用基础治疗(抗感染、袪痰、平喘、对症治疗)+Tα1注射液1.6 mg,皮下注射,每日1次,2周为一个疗程。对照组34例仅使用基础治疗。两组治疗前后对比观察各项免疫指标:外周血T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+);免疫球蛋白IgG、IgA、IgM、IgE;补体C3、C4水平和临床疗效评估。结果 T淋巴细胞表型变化比较,Tα1组治疗前CD3+为(57.75±7.80)%、CD4+为(33.43±5.27)%、CD4+/CD8+为1.41±0.46,均低于正常值,CD8+[(30.02±5.60)%]高于正常值。治疗后CD3+为(66.89±9.84)%、CD4+为(38.27±4.27)%、CD4+/CD8+为1.79±0.59,比治疗前均显著增高,CD8+[(25.03±4.27)%]比治疗前下降,示免疫指标有所改善,相比结果有统计学意义(P<0.05)。体液免疫指标变化比较:两组C3水平治疗前分别为(0.89±0.25)g/L、(0.86±0.37)g/L,较正常值均偏低,余体液免疫指标C4、IgG、IgA、IgE、IgM治疗前后相比无统计学差异(P>0.05)。临床疗效观察总有效率Tα1组88.2%,高于对照组67.6%,两组比较有统计学差异(χ2=8.171,P<0.05)。结论高龄老年肺部感染患者细胞免疫功能比体液免疫功能下降明显,体液免疫指标补体C3比C4水平下降敏感,应用Tα1辅助抗感染治疗可有效调节、改善免疫指标,恢复机体免疫功能,促进肺部炎症吸收,改善预后。

Objective To observe the changes of the cellular and humoral immune function in aged patients with lung infection and to investigate the values thymosin α1（Thymosin alpha-1, Tα1） regulates immune function in adjuvant treatment as well as clinical effect. Methods 68 elder patients （≥80 years） with pneumonia, were randomly divided into the treatment group （Tα1） and the control group, 34 cases in each group. Tα1 groups used the basic treatment （anti infection, eliminating phlegm, relieving asthma, symptomatic treatment） plus thymosinα1 injection（subcutaneous injection, once every second day, 2 weeks as a course）. The control group of 34 cases using only basic treatment. The two groups were observed before and after treatment and were compared by immune indexes： the peripheral blood T lymphocyte subsets （CD3＋, CD4＋, CD8＋, CD4＋/CD8＋）; immunoglobulin IgG, IgA, IgM, IgE, C4, complement C3 as well as the evaluation of clinical efficacy. Results For the changes of T lymphocyte phenotype, in Tα1 group, CD3＋, CD4＋, CD4＋/CD8＋ were （57.75±7.80）%, （33.43±5.27）%, 1.41±0.46 before treatment, lower than normal while CD8＋ was （30.02±5.60）%, higher than normal, CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ were （66.89±9.84）%, （38.27±4.27）%, （25.03±4.27）%, 1.79±0.59 respectively after treatment, demonstrating that CD3＋, CD4＋, CD4＋/CD8＋ were significantly increased while CD8＋significantly decreased （P〈0.05）; For the changes of humoral immunity, C3 were （0.89±0.25）g/L, （0.86±0.37）g/L in two groups, lower than normal;As to other humoral immunity indexes （C4, IgM, IgA, IgG）, there were no significant difference before and after treatment （P〉0.05）. For the clinical curative effect of the total efficiency, Tα1 group was 88.2%while control group was 67.6%, a significant difference between two groups （χ2=8.171, P〈0.05）. Conclusions Thymosin α1 can effectively regulate immune function in adjuvant treatment of aged patients with lung infection, restore immune function, promote the absorption of pulmonary inflammation, improve prognosis of the patient.