针刺对脓毒症患者免疫功能及预后的影响

Effect of Acupuncture on Prognosis and Immune Function of Sepsis Patients

目的研究针刺治疗对脓毒症患者免疫功能的影响。方法采用随机数字表法将90例脓毒症患者分为对照组、胸腺肽α1组及针刺治疗组,每组30例。对照组按照拯救脓毒症治疗指南(Surviving Sepsis Campaign,SSC)的方案治疗,在对照组治疗基础上胸腺肽α1组给予胸腺肽α1(1.6 mg)皮下注射,每日1次;针刺治疗组联合针刺足三里、阳陵泉、内关、关元等穴位,每日1次,均连续治疗6天。检测各组T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)及Ig G、Ig A、Ig M水平,并比较各组ICU住院时间、再次住院率及28天病死率。结果与本组治疗前比较,治疗后3组CD3+、CD4+、CD8+、CD4+/CD8+比值、Ig G、Ig A、Ig M均明显升高(P<0.01),其中胸腺肽α1组及针刺治疗组CD3+、CD4+、CD8+、Ig G、Ig A、Ig M升高更明显(P<0.01)。与对照组比较,胸腺肽α1组及针刺治疗组ICU住院时间缩短,再次住院率及28天病死率下降(P<0.05,P<0.01)。胸腺肽α1与针刺治疗组各指标比较,差异均无统计学意义(P>0.05)。结论针刺治疗能够改善免疫指标,调节脓毒症患者的免疫功能状态,改善患者预后。

Objective To study the effect of acupuncture on the immune function of sepsis patients. Methods Ninety sepsis patients were assigned to the control group,the thymosin α1group,and the acupuncture treatment group according to random digit table,30 patients in each group. Patients in the control group were treated according to the guideline of Surviving Sepsis Campaign（ SSC）. Patients in the control group received routine treatment. Those in the thymosin α1group additionally received subdermal injection of thymosin α1（ 1. 6 mg）,once per day for 6 successive days. Needling at related points such as Zusanli（ ST36）,Yanglingquan（ GB34）,Neiguan（ PC6）,Guanyuan（ RN4）,and so on,was performed in patients of the acupuncture treatment group,once per day for 6 successive days. T cell subgroups（ CD3＋,CD4＋,CD8＋,CD4＋/ CD8＋）and immunoglobulin levels（ Ig G,Ig A,Ig M） were detected. The length of ICU hospital stay,hospital readmission rate,and 28-day mortality were compared among the three groups. Results After six days of treatment,CD3＋,CD4＋,CD8＋,Ig G,Ig A,Ig M,and CD4＋/ CD8＋ratio of three groups were all significantly increased（P〈0. 01）. Of them,CD3＋,CD4＋,CD8＋,Ig G,Ig A,and Ig M increased more significantly in the thymosin α1group and the acupuncture treatment group（P〈0. 01）.Compared with the control group,the ICU hospitalization length was significantly shortened,the hospital readmission rate and the 28-day mortality were lower in the thymosin α1group and the acupuncture treatment group（P〈0. 05,P〈0. 01）. There was no statistical difference in each index between the thymosin α1group and the acupuncture treatment group（P〈0. 05）.Conclusion Acupuncture could adjust the immune function of sepsis patients,improve their immunological indicators and prognoses.