低剂量甲泼尼龙治疗脓毒血症的疗效及其对患者免疫功能的影响

Curative effect of low-dose methylprednisolonein in the treatment of sepsis and its influence on the immune function

目的观察低剂量甲泼尼龙治疗脓毒血症的疗效,并探讨其对患者免疫功能的影响。方法选取我院重症医学科2014年3月至2016年2月收治的脓毒血症患者68例,按照就诊时间顺序分为对照组与观察组,每组各34例,对照组给予常规治疗,观察组在对照组基础上加用低剂量甲泼尼龙治疗,静脉注射40 mg低剂量甲泼尼龙,连续治疗3 d,比较两组患者的疗效及免疫功能的变化情况。结果观察组患者治疗后的肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、白细胞介素-1(IL-1)水平分别为(7.23±0.87)pg/m L、(12.11±3.41)pg/m L、(24.52±13.56)pg/m L,两组治疗后与治疗前相比TNF-α、IL-10、IL-1水平均明显降低,观察组治疗后与对照组治疗后相比TNF-α、IL-10、IL-1水平降低更加显著,差异均具有统计学意义(P<0.05);观察组患者治疗后CD4+、CD8+水平分别为(20.01±2.66)%、(36.45±1.61)%,两组患者治疗后与治疗前比较CD4+、CD8+水平均升高,观察组治疗后与对照组治疗后相比CD4+、CD8+升高更加显著,差异具有统计学意义(P<0.05);对照组患者死亡率为23.53%,明显高于观察组的5.88%,差异具有统计学意义(P<0.05)。结论于常规用药的基础上加用低剂量甲泼尼龙治疗脓毒血症的疗效显著,其可有效改善炎症因子水平及机体免疫功能,患者存活率较高。

Objective To investigate the curative effect of low-dose methylprednisolonein in the treatment of sepsis and its influence on the immune function. Methods A total of 68 patients with sepsis, who admitted to Intensive Care Unit of our hospital from March 2014 to February 2016, were selected and divided into the control group and the observation group according to the chronological order of visits, with 34 cases in each group. The control group was treated with conventional treatment, and the observation group was treated with low-dose methylprednisolone（40 mg）on the basis of the control group for three days. The curative effect of low-dose methylprednisolonein and its influence on the immune function were compared. Results The levels of TUMOUR-necrosis factor-α（TNF-α）, interleukin 10（IL-10）, interleukin 1（IL-1） were respectively（7.23±0.87） pg/m L,（12.11±3.41） pg/m L and（24.52±13.56） pg/m L. The levels of TNF-α, IL-10 and IL-1 of the two groups after treatment were significantly lower than before the treatment（P〈0.05）. After the treatment, the levels of TNF-α, IL-10 and IL-1 of the observation group were significantly lower than those of the control group（P〈0.05）. The levels of CD4＋and CD8＋were respectively（20.01±2.66）% and（36.45±1.61）%. The levels of CD4＋and CD8＋of the two groups after treatment were significantly higher than before the treatment（P〈0.05）. After the treatment, the levels of CD4＋and CD8＋of the observation group were significantly higher than those of the control group（P〈0.05）. The mortality rate in the control group was 23.53%, which was significantly higher than 5.88% in the observation group（P〈0.05）. Conclusion The combination of conventional medication and low-dose of methylprednisolone was effective in the treatment of sepsis, which can effectively improve the inflammatory factor levels, the body＇s immune function, and survival rate.