乌司他丁联合胸腺肽α1对脓毒症患者免疫调理的临床疗效分析

To analyze the clinical effects of ulinastatin and thymosinα1on immune-modulation in septic patients

目的:分析乌司他丁联合胸腺肽α1对脓毒症患者免疫调理的临床疗效。方法:将符合入选标准的172例脓毒症患者随机分为对照组和治疗组。对照组88例,采用SSC经典治疗;治疗组84例,在SSC经典治疗的基础上加用乌司他丁和胸腺肽α1联合治疗。用酶联免疫吸附法(ELASA)检测2组患者治疗前后血清IL-6、IL-10、TNF-α,用流式细胞仪检测2组患者治疗前后外周静脉血CD14+单核细胞人类白细胞抗原-DR(HLA-DR)表达率。观察2组患者APACHEⅡ评分、28d病死率、MODS发生率、机械通气时间、感染病程和ICU住院天数及治疗前后上述免疫指标的变化。结果:①2组患者治疗前各指标差异均无统计学意义;②治疗组治疗后外周静脉血HLA-DR表达率明显升高,血清IL-6、IL-10、TNF-α含量明显降低,且与对照组比较差异有统计学意义(P<0.05);③治疗组APACHEⅡ评分明显下降,且与对照组比较差异有统计学意义,28d病死率、MODS发生率、机械通气时间明显低于对照组(P<0.05),但2组患者感染病程及ICU住院天数比较差异无统计学意义。结论:乌司他丁联合胸腺肽α1的免疫调节治疗能显著改善脓毒症患者免疫失衡状态,明显改善APACHEⅡ评分,并降低28d病死率、MODS发生率及减少机械通气时间,但对感染病程及ICU住院天数则无明显影响。

Objective：To analyze the clinical effects of immuno-modulatory therapy with ulinastatin and thymosin α1 on patients with sepsis. Method： 172 septic patients admitted to Hubei ZhongShan Hospital intensive care unit （ICU） during 2010.02-2013.4 were included, and they were randomly divided into treatment group（84 cases） and control group（88 cases）. The patients in control group were given regular conventional treatment according to Surviving Sepsis Campaign（SSC）. The treatment group received conventional treatment plus immuno-modulation therapy including ulinastatin and thymosin al. The levels serum IL-6, IL-10 and TNF-α of peripheral blood were detected by ELISA. Peripheral blood CD14^＋ monocyte human leucoeyte antigen DR（HLA-DR） expression were assessed with flow cytometer. General demographics were observed,and acute physiology and chronic health evaluation II （APACHE II）scores were recorded. Duration of infection and mechanical ventilation,length of ICU stay, rate of development of multiple organ dysfunction syndrome（MODS） and mortality rate on 28 days were observed. Result： ①Before treatment,there was no difference in all biomarkers between the two groups. ②After treatment, peripheral blood CD14＋ monoeyte, HLA-DR expression increased significantly in the treatment group（P〈0.05）, while serum IL-6,IL-10and TNF-α levels reduced remarkably（P〈0.05）. The values showed significant differences compared with those of control group（P〈0.05）. ③APACHE Ⅱ scores reduced remarkably（P〈0.05）. The values showed significant differences compared with those of control group（P〈0.05）. The MODS development rate in the treatment group was much lower than that of control group（P〈0.05）, and the length of use of mechanical ventilation was significantly reduced （P〈0.05）. There was no difference in the infection duration and length of ICU stay（P〉0.05）. The mortality rate on 28 days in the treatment group was much lower than that in control group. Conclusion：The immuno-modulation therapy of ulinastatin and thymosin α1 can remarkably improve the duration of mechanical ventilation, the development rate of MODS and the mortality rate on 28 days in patients with sepsis,probably due to its effect in ameliorating the immuno-imbalance state. However, the duration of infection and length of ICU stay are not effeeted.