乌司他丁对胃肠道术后炎性因子与外周血T淋巴细胞亚群的影响

Effects of ulinastatin on postoperative peripheral blood inflammatory factors and T lymphocyte subsets in patients with gastrointestinal operation

目的观察胃肠道手术术前静脉滴注乌司他丁对术后炎性因子与外周血T淋巴细胞亚群的影响,探讨其作用机制。方法选择2012年7月至2014年6月收治的115例胃肠道手术患者随机分为研究组(60例)和对照组(55例),研究组手术麻醉诱导前静脉滴注乌司他丁2.5kU/kg,对照组静脉滴注5%葡萄糖氯化钠注射液,术后常规处理,比较术前及术后1、3d的血清炎性因子水平及外周血T淋巴细胞亚群变化情况。结果两组术后1、3d白细胞介素(IL)-6、IL-8、IL-10、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)水平呈先上升、后下降趋势;研究组术后1、3d的IL-6、IL-8、TNF-α、CRP水平均明显低于对照组,IL-10则高于对照组,差异均有统计学意义(P<0.05)。两组术后1、3dT淋巴细胞亚群中CD4^+、CD8^+呈先下降、后上升趋势,研究组CD4^+/CD8^+逐渐上升,对照组CD4^+/CD8^+先下降、后上升;研究组术后1、3dCD4^+与CD4^+/CD8^+均明显高于对照组,差异有统计学意义(P<0.05),CD8^+低于对照组,差异无统计学意义(P>0.05)。结论胃肠道手术应用乌司他丁能有效降低炎性介质的释放,改善手术应激状态时的细胞免疫功能,减轻手术造成功能性器官的损害。

Objective To observe the effects of ulinastatin on postoperative peripheral blood inflammatory cytokines and T lymphocyte subsets in the patients with gastrointestinal operation,and to explore its protective mechanism.Methods 115 patients with gastrointestinal operation from July 2012 to June 2014 were selected and randomly divided into the study group（60cases）and the control group（55cases）.The study group was intravenously dripped with ulinastatin 2.5kU/kg before anesthesia induction,while the control group with 5% glucose and sodium chloride injection.All patients were performed the postoperative routine treatment.The variation situation of serum inflammatory factors and peripheral blood T cell subsets were compared between before and after treatment in the two groups.Results The IL-6,IL-8,IL-10,TNF-αand CRP levels on postoperative 1,3d in 2groups showed first increasing and then decreasing trend;the IL-6,IL-8,TNF-αand CRP levels on postoperative 1,3d in the study group were significantly lower than those in the control group,while the IL-10 level was higher than that in the control group,the differences were statistically significant（P〈0.05）.The CD4~＋and CD8~＋of T cell subsets on postoperative 1,3d in the two groups showed first decreasing and then increasing trend,the CD4~＋/CD8~＋ratio in the study group was increased gradually,while which in the control group was firstly decreased and then increased;the CD4~＋and CD4~＋/CD8~＋on postoperative 1,3d in the study group were significantly higher than those in the control group,the differences were statistically significant（P〈0.05）,while the CD8~＋was lower than that in the control group,but the difference was not statistically significant（P〉0.05）.Conclusion The application of ulinastatin before gastrointestinal operation can effectively reduce the releasing of inflammatory mediators,improves the cellular immune function in the operative stress state and then alleviate the functional organ damage.