免疫治疗对重症肺炎患者免疫功能指标的影响研究

Effect of immunotherapy on immune function indicators in severe pneumonia patients

目的研究免疫治疗对重症肺炎患者CD14+单核细胞人白细胞抗原-DR(mHLA-DR)表达、T细胞亚群等免疫功能指标以及肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平的影响,探讨重症肺炎患者进行免疫治疗的可行性。方法选择2010年1月-2012年12月重症监护病房(ICU)和呼吸科治疗的重症肺炎患者96例,将其随机分成治疗组50例与对照组46例,对照组给予常规治疗,治疗组在常规治疗基础上使用胸腺肽α1共7d,进行免疫治疗,比较两组患者治疗前后mHLA-DR表达、T细胞亚群以及TNF-α、IL-6水平的变化,同时对肺部感染控制窗出现时间、治疗总有效率、病死率等临床疗效进行评价。结果治疗组在治疗后mHLA-DR表达率上升,CD4+和CD4+/CD8+显著升高,CD8+、TNF-α和IL-6显著降低,治疗前后差异均有统计学意义(P<0.05),而对照组治疗前后上述指标的差异无统计学意义;治疗7d后肺部感染控制窗出现时间、治疗总有效率、病死率分别为(8.5±2.6)d、72.0%、12.0%,均优于对照组的(11.2±2.5)d、50.0%、30.4%,差异有统计学意义(P<0.05)。结论使用胸腺肽α1进行免疫治疗后,能够提高重症肺炎患者细胞免疫功能,减轻全身炎症反应,并能提高临床疗效,改善预后;免疫治疗7d后mHLA-DR表达率≥40.0%,可作为预测免疫治疗有反应性的指标。

OBJECTIVE To study the effect of immunotherapy on expression of CD14 ＋ mHLA-DR , immune functional parameters of T cell subset ,and the levels of tumor necrosis factor （TNF-α） and interleukin-6 （IL-6） and to discuss the feasibility for severe pneumonia patients to receive immunotherapy .METHODS A total of 96 severe pneumonia patients treated in intensive care unit （ICU ） and pneumology department from Jan 2010 to Dec 2012 were selected and were randomly divided into treatment group （50 cases） and control group （46 cases） .The control group was given conventional therapy , and the treatment group was given thymosin α1 for immune treatment for 7 days on the basis of conventional therapy .The mHLA-DR expression ,T cell subset and the level of TNF-αand IL-6 of the two groups before and after the treatment were compared ,and the occurrence time of pulmonary infection control window , total effective rate and case fatility rate and the like were evaluated . RESULTS After treatment , the mHLA-DR expression rate was increased , CD4 ＋ and CD4 ＋ /CD8 ＋ were significantly increased ,CD8 ＋ 、TNF-α and IL-6 were significantly decreased after treatment （P〈 0 .05）;while , there was no statistically significant difference between the above indicators before and after treatment ;7 days later after treatment ,the occurrence time of pulmonary infection control window （8 .5 ± 2 .6 d） ,total effective rate （72 .0% ） ,and fatility rate （72 .0% ） of the treatment group were all higher than （11 .2 ± 2 .5）d ,50 .0% and 30 .4% of control group ;there was significant difference （P〈0 .05） .CONCLUSIONS After immune treatment with the use of thymosinα1 ,it is able to improve the cellular immune function of severe puneumonia patients ,relieve systemic inflammatory response , improve clinical curative effect and improve prognosis ;40 .0% mHLA-DR expression rate and above after 7 days immune treatment can be taken as an indicator predicting reactive immune treatment .