乌司他丁对脓毒症患者肾损伤的保护作用及对免疫功能的影响

Protective effects and influence on immune function of Ulinastatin for the septic patients with renal injury

目的：探讨乌司他丁对于脓毒症肾损伤的保护作用，并分析其对预后及免疫功能的影响，并探讨其可能的作用机制，为临床治疗提供依据。方法选择2010年3月~2014年2月浙江省丽水市人民医院收治的脓毒症患者46例，随机将所有患者分为对照组（22例）和观察组（24例），对照组患者给予常规治疗和护理；观察组患者在常规治疗基础上应用乌司他丁治疗。主要评估患者治疗前后血尿素氮（BUN）、血肌酐（SCr）和胱抑素C（Cystatin C）含量、T细胞亚群结果，检测血清中肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）水平，并进行急性生理与慢性健康（APACHEⅡ）评分。结果两组患者治疗后Cystatin C、BUN和SCr均低于治疗前，差异均有统计学意义（P＜0.05）；观察组患者治疗后Cystatin C、BUN和SCr分别为（1.21±0.24）mg/L、（14.92±1.23）mmol/L和（210.74±18.36）μmol/L，均低于对照组患者治疗后[（1.57±0.16）mg/L、（16.12±1.04）mmol/L和（254.33±23.82）μmol/L]（P＜0.05）；两组患者治疗后CD4＋、CD8＋和CD4＋/CD8＋与治疗前比较，差异均有统计学意义（P＜0.05）。观察组患者治疗后CD4＋和CD4＋/CD8＋分别为（43.87±5.04）%和（1.82±0.29），均高于对照组治疗后[（38.04±4.51）%、（1.30±0.37）]（P＜0.05）。观察组患者治疗后CD8＋为（31.92±3.26）%，低于对照组治疗后[（35.42±3.11）%]，差异有统计学意义（P＜0.05）。两组患者治疗后TNF-α和IL-6与治疗前比较，差异均有统计学意义（P＜0.05）。观察组患者治疗后TNF-α和IL-6分别为（201.66±17.44）、（173.54±15.8）ng/L，均低于对照组治疗后[（236.85±19.51）、（217.96±20.32）ng/L]，差异有统计学意义（P＜0.05）。观察组患者治疗后APACHEⅡ评分为（15.60±1.23）分，低于对照组治疗后[（19.24±1.65）分]，且两组患者治疗后均低于治疗前（P＜0.05）。结论乌司他丁对于脓毒症肾损伤患者具有保护作用，且能够显著改善患者的免疫功能，降低炎性因子，值得临床推广应用。

Objective To explore the protective effects of Ulinastatin for the septic patients with renal injury, to analyze the influence on the prognosis and immune function, and to investigate its possible mechanism, and provide the basis for clinical therapy. Methods Forty six patients with sepsis were selected in the People＆#39;s Hospital of Lishui City from March 2010 to February 2014. They were randomly divided into the control group （22 cases）, who were treated with conventional treatment and nursing, and the observation group （24 cases） were treated with Ulinastatin on the basis of conventional therapy. The blood urea nitrogen （BUN） and serum creatinine （SCr） and Cystatin C （Cystatin C）, T cell subsets were evaluated, the serum tumor necrosis factor-α （TNF-α） and interleukin -6 （IL-6） level, and acute physiology and chronic health evaluation （APACHE II） scores before and after treatment were detected. Results Cystatin, C, BUN and SCr of two groups after treatment were obviously lower than those before treatment, the differences were statistically significant （P〈0.05）. Cystatin C, BUN and SCr of the observation group after treatment were （1.21±0.24） mg/L, （14.92±1.23） mmol/L and （210.74±18.36） μmol/L, lower than the control group after treatment [（1.57±0.16） mg/L, （16.12±1.04） mmol/L and （254.33±23.82） μmol/L] （P〈 0.05）. Compared to before treatment, CD4＋, CD8＋ and CD4＋/CD8＋ of two groups, the differences were statistically significant （P〈0.05）. CD4＋and CD4＋/CD8＋of the observation group after treatment was （43.87±5.04）% and （1.82±0.29）, higher than that of the control group after treatment [（38.04±4.51）% and （1.30±0.37）] （P 〈 0.05）. CD8＋ of the observation group after treatment was （31.92±3.26）%, lower than the control group after treatment [（35.42±3.11）%] （P〈0.05）. TNF-αand IL-6 of two groups after treatment compared with before treatment, the difference was statistically significant （P 〈 0.05）. TNF-αand IL-6 of the observation group after treatment were （201.66±17.44）, （173.54±15.8） ng/L, lower than the control group after treatment [（236.85±19.51）, （217.96±20.32） ng/L], there was a significant difference （P〈 0.05）. APACHEIIscore of the observation group after treatment was （15.60±1.23） scores, lower than the control group after treatment [（19.24±1.65） scores], and the two groups after treatment were lower than those before treatment （P〈0.05）. Conclusion There is better protective of Ulinastatin on septic renal injury, which can obviously improve the immune function, reduce the inflammatory factor, and it is worthy of clinical application.