辛伐他汀在脓毒症和严重脓毒症患者中对血液白细胞介素-6水平的影响

Influence of simvastatin treatment on plasma interleukin-6 in patients with sepsis and severe sepsis

目的 观察比较辛伐他汀在脓毒症患者和严重脓毒症患者中对血液白细胞介素-6（IL-6）水平的影响.方法 54例脓毒症患者和47例严重脓毒症患者为研究对象,两种类型的患者均随机分为对照组和辛伐他汀组.辛伐他汀组患者接受每天40 mg辛伐他汀治疗至少15d,其他治疗与对照组差异无统计学意义.在入院第1、5、10、15天分别采集患者抗凝血,通过酶联免疫吸附试验（ELISA）测定血浆IL-6水平,通过Wileoxon秩和检验比较不同组间IL-6水平的差异.结果 在脓毒症患者中,与对照组比较,辛伐他汀治疗组患者血浆IL-6水平显著降低,且随着辛伐他汀治疗时间延长有下降趋势,入院第1、5、10、15天,辛伐他汀治疗组血浆IL-6水平中位数分别为133、68、48、35 pg/ml,对照组血浆IL-6水平中位数分别为136、96、67、62 pg/ml;入院第10、15天,辛伐他汀治疗组和对照组患者血浆IL-6水平之间差异有统计学意义（P＜0.05）.在重症脓毒症患者中,入院第1、5、10、15天,辛伐他汀治疗组血浆IL-6水平中位数分别为284、158、92、72 pg/ml,对照组患者血浆IL-6水平中位数分别为276、163、97、78 pg/ml;辛伐他汀治疗组患者血浆IL-6水平虽然随着辛伐他汀治疗时间的延长有下降趋势,但与对照组比较,血浆IL-6水平无明显变化.结论 他汀类药物在脓毒症患者和严重脓毒症患者中对血浆IL-6的影响不同.

Objective To investigate the influence of simvastatin treatment on plasma interleukin-6 （IL-6） in patients with sepsis and severe sepsis.Methods A prospective randomized controlled clinical trial was conducted on 54 patients with sepsis and 47 patients with severe sepsis admitted to the Department of Critical Care Medicine of Henan Provincial People＇s Hospital from August 2013 to August 2014.Those two types of patients were randomized into control group and simvastatin group respectively.Except the same treatments in control group,patients in simvastatin group received an additional 40 mg simvastatin daily for at least 15 days.On the day 1,5,10,and 15 after admission the blood samples were collected and the IL-6 concentrations were determined by enzyme linked immunosorbent assay （ELISA）.Wilcoxon rank sum test was performed to compare the IL-6 levels between different groups.Results In patients with sepsis,IL-6 level was significantly decreased from 10 days up to 15 days in simvastatin group as compared with that in conventional therapy group （48 vs.67 pg/ml at 10th day,P 〈 0.05;35 vs.62 pg/ml at 15th day,P 〈 0.05）.However,in patients with severe sepsis,simvastatin treatment had no significant influence on plasma IL-6 concentration.Conclusion Simvastatin treatment differently regulates plasma IL-6 levels in septic and severe septic patients,which partially explains the discrepancy previously reported about the therapeutic effects of statin therapy.