重症脓毒症患者外周血Th1与Th2的分布特点及乌司他丁的干预作用研究

Th1/Th2distribution of severe sepsis and the intervention of ulinastatin

目的分析乌司他丁对重症脓毒症患者的外周血Th1/Th2的影响,为完善其抗炎药理机制提供依据。方法采用前瞻性研究,将医院2014年9月-2015年10月收治93例重症脓毒症患者,随机分为常规治疗组46例和乌司他丁组47例,常规治疗组患者采用常规综合疗法,乌司他丁组患者在常规治疗组基础上静脉滴注乌司他丁30万U,8h1次,疗程5d,分别于治疗前后抽取空腹静脉血,以流式细胞仪检测Th1、Th2细胞比例,以ELISA试剂盒检测IL-2、IL-10的血清水平,并以33例同期志愿者为对照组,进行对比研究。结果治疗前,常规治疗组和乌司他丁组Th1、Th2细胞比例,IL-2、IL-10血清水平均高于对照组,差异有统计学意义(P<0.05),但常规治疗组和乌司他丁组比较差异无统计学意义;治疗后,乌司他丁组Th1、Th2细胞比例、IL-2、IL-10血清水平低于常规治疗组,Th1/Th2、IL-2/IL-10高于常规治疗组,差异有统计学意义(P<0.05)。结论乌司他丁能够改善重症脓毒症患者Th1/Th2漂移,维持促炎/抗炎稳态,从而改善脓毒症患者病情。

OBJECTIVE To analyze the influence of ulinastatin to Th1/Th2 of peripheral blood of patients with severe sepsis,so as to provide evidence for the completing of its anti-inflammatory mechanism.METHODS A total of93 patients with severe sepsis accepted from Sep.2014 to Oct.2015 were selected and randomly divided into 2groups,including 46 cases of conservative therapy group and 47 cases of ulinastatin group.Patients in conservative therapy group were given comprehensive therapy,while patients in ulinastatin group were given ulinastatin on the base of comprehensive therapy（300,000 U,q8h,for 5days）.The fasting venous blood before and after treatment was extracted to detect the Th1 and Th2cell percentage by flow cytometry,and the serum levels of IL-2and IL-10 were detected by ELISA kits.A total of 33 cases of volunteers were selected as control group,and compared with other groups.RESULTS Before treatment,the Th1 and Th2cell percentage,and the serum levels of IL-2and IL-10 of patients of conservative therapy group were all higher than those of control group,while Th1/Th2 and IL-2/IL-10 were both lower than those of control group（P〈0.05）;but there was no significant difference between conservative therapy group and ulinastatin group.After treatment,the Th1 and Th2cell percentage,and the serum levels of IL-2and IL-10 of ulinastatin group were all lower than those of conservative therapy group,while Th1/Th2 and IL-2/IL-10 were both higher than those of conservative therapy group（P〈0.05）.CONCLUSION Ulinastatin has ability to approve the Th1/Th2 drifting of patients with severe sepsis,which is benefit to maintain pro-inflammatory/anti-inflammatory steady state and improve the condition of patients.