乌司他丁对脓毒症患者血清肿瘤坏死因子-α、白细胞介素10、肌钙蛋白I和C反应蛋白水平的影响

Effect of ulinastatin on the serum levels of tumor necrosis factor α,interleukin 10,troponin I and C-reactive protein

目的：通过观察患者细胞因子水平的变化来探讨乌司他丁在脓毒症中的作用机制,旨在评价乌司他丁对人脓毒症的疗效,并评价肌钙蛋白I（cTnI）、C反应蛋白（CRP）用于脓毒症病情评价和预后评估的意义。方法：采用前瞻性对照研究,收集符合脓毒症诊断标准的患者60例,随机分为乌司他丁组和对照组。在相同的常规治疗基础上,乌司他丁组给予乌司他丁针20万U静脉注射,8 h 1次。对照组则给予同等量的0.9%氯化钠注射液。所有患者在治疗前和治疗后48 h、120 h,进行急性生理和慢性健康状况评分（APACHEⅡ评分）,并测定血清肿瘤坏死因子α（TNF-α）、白细胞介素10（IL-10）、CRP、cTnI的水平,计算2组患者的28 d病死率。结果：治疗前2组患者血清TNF-α、IL-10、cTnI、CRP和APACHEⅡ评分治疗前差异均无统计学意义（P〉0.05）。治疗后48 h、120 h乌司他丁组的TNF-α、CRP水平和APACHEⅡ评分均低于对照组（P〈0.05~P〈0.01）。治疗后48 h和120 h乌司他丁组的IL-10水平均明显高于对照组（P〈0.01）。乌司他丁组患者治疗后48 h、120 h cTnI、CRP水平与APACHEⅡ评分均较治疗前明显下降（P〈0.01）。2组28 d病死率差异无统计学意义（P〉0.05）。结论：脓毒症患者应用乌司他丁治疗后虽不能降低28 d病死率,但可减轻脓毒症患者炎症反应,较快改善脓毒症患者病情,其机制可能为通过降低促炎因子TNF-α、升高抑炎因子IL-10水平实现的。

Objective： To explore the troponin I mechanism of action ulinastatin in sepsis patients by observing the change of cytokine,evaluate the efficacy of ulinastatin and significance of troponin I（ cTnI） and C-reactive protein（ CRP） in the disease condition and prognosis of sepsis. Methods： Sixty patients with sepsis were selected by the prospective controlled study,and randomly divided into the ulinastatin group（ group A） and control group（ group B）. Based on the same conventional treatment,the group A were treated with200,000 U ulinastatin by intravenous once 8 hours,and the group B were treated with the same amount of saline. Before treatment and after 48 h and 120 h of treatment,the acute physiology and chronic health evaluation scores（ APACHE Ⅱ score） in all patients were investigated,the serum levels of tumor necrosis factor α（ TNF-α）,interleukin-10（ IL-10）,CRP and cTnI in two groups were detected,and the 28-day mortality in patients were calculate. Results： The differences of the serum levels of TNF-α,IL-10,cTnI and CRP,and the APACHE Ⅱ score between two groups before treatment were not statistically significant（ P〉0. 05）. After 48 h and 120 h of treatment,the levels of TNF-α,CRP and the APACHE Ⅱ score in group A were lower than those in group B（ P〈0. 05 to P〈0. 01）,and the level of IL-10 in group A was significantly higher than that in group B（ P〈0. 01）. Compared before treatment,the levels of cTnI and CRP,and the APACHEⅡ score in group A significantly decreased after 48 h and 120 h of treatment（ P〈0. 01）. The difference of the 28-day mortality between two groups was not statistically significant（ P〉0. 05）. Conclusions： The treatment of sepsis with ulinastatin can not reduce the 28-day mortality,but it can alleviate the inflammatory response,and improve the condition of patients,the mechanism of which may involve in decreasing the level of TNF-α and increasing the level of IL-10.