胸腺肽-α1对脓毒症患者血清IL-8及IL-10的调节作用

Modulation of interleukin-8 and interlukin-10 in serum by thymosin alpha1 in septic patients

目的观察胸腺肽-α1对脓毒症患者免疫紊乱的调节作用及对预后的影响。方法采用单中心前瞻性随机对照研究,纳入2015年7月-2017年1月东莞市第三人民医院重症医学科收治的脓毒症患者70例,按是否使用胸腺肽-α1(Tα1)分为药物组(n=35)和安慰剂组(n=35)。采用ELISA法测定两组患者治疗后第1天(d1)、第5天(d5)和第10天(d10)的血清IL-8和IL-10浓度,计算IL-8/IL-10比值;记录患者入院时的APPACHEⅡ评分及ICU住院时间,分析好转率;检测两组血清白细胞计数(WBC)及降钙素原(PCT)水平。结果 d1时药物组血清IL-8、IL-10及IL-8/IL-10与安慰剂组比较差异无统计学意义(P>0.05),d5和d10时药物组IL-8及IL-8/IL-10比值明显高于安慰剂组(P<0.05),但IL-10水平在两组间差异无统计学意义(P>0.05)。在d1、d5和d10时点,两组WBC、PCT比较差异均无统计学意义(P>0.05)。在药物组,IL-8和IL-8/IL-10随时间呈进行性升高,IL-10则随时间呈进行性下降,且均在d5和d10时出现明显差异(P<0.05)。两组WBC和PCT随时间呈进行性下降,d5与d1比较、d10与d5比较差异均有统计学意义(P<0.05)。药物组ICU住院时间为(13.30±2.96)d,与安慰剂组[(15.50±5.43)d]比较明显缩短,差异有统计学意义(P<0.05)。药物组好转率(85.7%)明显高于安慰剂组(68.6%),差异有统计学意义(P<0.01)。结论 Tα1能明显提高脓毒症患者血清IL-8水平,改善免疫紊乱,缩短入住ICU时间,改善预后。

Objective To evaluate the modulatory effect of thymosin alpha1 on the immune dysfunction and prognosis in septic patients. Methods In a prospective random-control study, 70 sepsis patients were randomly and equally divided into drug group and placebo group according to the use of thymosin alpha1 or not. The serum interleukin-8 and interleukin-10 were assayed by ELISA. The ratio of IL-8/IL-10 was calculated, the duration in ICU and the initial APPACHEⅡscore were recorded. The differences between patients group and control group, as well as drug group and placebo group, were compared. The sequential changes of white blood cells(WBCs), procalcitonin(PCT), IL-8, IL-10 in the drug group and placebo group were observed. Results In day 1, the differences of IL-8, IL-10, and IL-8/IL-10 were not significant between drug group and placebo group. In day 5 and day 10, IL-8 and IL-8/IL-10 were significantly higher in drug group than in placebo group(P<0.05). But the difference of IL-10 between the two groups was not significant. In drug group, IL-8 and IL-8/IL-10 progressively elevated over time, and significant differences occurred between the day 5 and day 10(P<0.05). IL-10 declined progressively, and a clear difference was found between the day 5 and day 10. Also, WBCs and PCT declined, significant difference was seen between the day 1 and day 5, and between the day 5 and day 10. In placebo group, the changes of IL-8, IL-10 and IL-8/IL-10 were not significant between the day 1 and day 5 and between the day 5 and day 10. In drug group, the ICU stays was shorter(P<0.05). The improvement rate was higher in drug group(P<0.01). Conclusion Thymosin alpha 1 could enhance the level of serum IL-8, modulate immune paralysis, shorten the ICU stays and improve the prognosis of septic patients.