胸腺肽1对严重脓毒症患者的疗效观察

The efficacy of thymosin alpha 1 for severe sepsis

目的观察胸腺肽α（Tα1）对严重脓毒症患者预后和免疫功能的影响。方法收集2013-01—2014—12人住我院重症医学科符合标准的患者244例，根据患者是否予Tα治疗分为Ted组（rt=127）和非Ted组（n=117），然后根据确诊严重脓毒症后第1天淋巴细胞计数（LY）分为三个亚组，即≥1．00×109／L、（0．50-1．00）×109／L和≤0．50×109几亚组。收集患者的性别、年龄、APACHEI／评分、SOFA评分、LY、引起脓毒症的原发感染灶和预后等指标。为观察Tα1对严重脓毒症患者免疫功能的影响，用脂多糖体外刺激外周血单个核细胞（PBMcs）检测刺激后肿瘤坏死因子-α（TNF-α）浓度。每例严重脓毒症患者的PBMCs均被分为三组：对照组、脂多糖（LPS）组和LPS＋Tα1组，用ELISA试剂盒检测每组中TNF-α浓度。结果两组28d病死率及生存时间差异均无统计学意义（均P〉0．05），两组患者根据LY分层后，在LYe〈0．50×109／L亚组，Tα1组患者28d死亡率显著低于非Tα1组，生存时间显著长于非Tα1组（均P〈0．05）。体外试验显示，LPS＋Tα1组中TNF-α浓度高于对照组和LPS组（均P〈0．05）。结论Tα1能够显著改善LYe〈0．50×109／L的严重脓毒症患者的预后，提高严重脓毒症患者的免疫功能。

Objective To observe whether thymosin alpha 1 （Tα） improves prognosis and im- mune function of patients with severe sepsis. Methods We retrospectively collected patient information between January 2013 and December 2014 at our department. According to Tα 1 treatment, patients with severe sepsis were divided into Tα1 group （n= 127） and non-Tα1 group （n = 117）. Patients in both groups were also stratified according to lymphocyte count on Day 1 （the day when patients were diag- nosed with severe sepsis） into the following subgroups： ≥1.00×109 lymphocytes/L, （0.50-1.00） ×109lymphocytes/L, and ≤0.50×109 lymphocytes/L. Gender, age, APACHE II score, SOFA score, lymphocyte, site of infection causing sepsis and prognosis were retrospectively collected. We performed experi- ments in vitro to observe the effect of Tcd on immune function in patients with severe sepsis; this was done by evaluating tumor necrosis factor-alpha （TNF-α） levels in peripheral blood mononuclear cells （PBMCs） stimulated by hpopolysaccharide （LPS）. PBMCs from each patient with severe sepsis were di- vided into three groups： the control group, the LPS group, and the LPS＋Tα1 group. The concentrations of TNF-α from each group were tested by ELISA. Results All-cause mortality of patients at 28 days, for both groups, was not significantly different （P 〉 0.05） , and survival time was also similar （P 〉 0.05）. When patients were stratified by lymphocyte count, all-cause mortality at 28 days for the subgroup with lymphocyte count 0.5×10 9/L was significantly lower in Tα1 group than non-Tα1 group （P〈0.05）. The survival time of patients in Tα1 group was significantly longer than for those in non-Tα1 group （P〈 0.05）. In vitro experiments showed markedly higher TNF-αlevels in the LPS＋Tα1 group, compared with the control group and the LPS group （P〈0.05 ,respectively）. Conclusion The present study indi- cates that Tα1 can significantly improve the prognosis of severe sepsis patients with lymphocyte count ≤0.50×109/L,and improve immune function in patients with severe sepsis.