乌司他丁对脓毒症患者CD^(4+)CD^(25+)调节性T细胞变化的影响及其与预后的关系

Effect of ulinastatin on regulatory T cells of CD^(4+)CD^(25+) and its relationship with prognosis of the sepsis patients

目的探讨乌司他丁对脓毒症患者CD^(4+)CD^(25+)调节性T细胞(Treg)的影响及其与预后的关系。方法脓毒症患者随机分为乌司他丁治疗组和对照组,对照组给予常规的脓毒症治疗,乌司他丁治疗组在对照组的基础上加用乌司他丁治疗。分别于确诊后第1天、第3天、第5天比较两组间CD^(4+)CD^(25+)细胞/CD^(4+)细胞比例、白介素(IL-10)水平以及28 d死亡率。结果乌司他丁治疗组患者的病死率和ICU住院时间均低于对照组,差异均有统计学意义(χ~2=4.21,t=3.12,P均<0.05)。乌司他丁治疗组患者的CD^(4+)CD^(25+)细胞/CD^(4+)细胞比例和血清IL-10值在第1、3、5天组内比较,差异均有统计学意义(Hc分别=114.58、45.93,P均<0.05);乌司他丁治疗组第3天CD^(4+)CD^(25+)细胞/CD^(4+)细胞比例和IL-10值均高于第1天,第5天比例较第3天明显下降,差异均有统计学意义(t分别=10.57、6.43、3.73、5.08,P均<0.05)。在第3天,乌司他丁治疗组CD^(4+)CD^(25+)细胞/CD^(4+)细胞比例低于对照组,在第5天CD^(4+)CD^(25+)细胞/CD^(4+)细胞比例和IL-10值明显低于对照组,差异均有统计学意义(t分别=2.38、7.97、5.79,P均<0.05)。结论乌司他丁能抑制脓毒症患者CD^(4+)CD^(25+)Treg及IL-10的持续上升,避免出现免疫麻痹,降低病死率。

Objective To evaluate the effect of ulinastatin on regulatory T cells of CD^4＋CD^25＋ and its relationship with prognosis of the sepsis patients. Methods The sepsis patients were randomized into ulinastatin treatment group and control group. The control group was given the normal treatment for sepsis,the ulinastafin treatment group was given ulinastatin drugs based on the treatment of control group. The CD^4＋CD^25＋ ratio,IL-10,and 28-day mortality were measured in two groups on the first,third,and fifth day. Results There were significant differences in mortality and ICU hospitalization time between the ulinastatin treatment group and control group （X^2=4.21,t=3.12,P〈0.05）. The CCD^4＋CD^25＋ ratio and serum IL-10 level on the first,third,and fifth day of the ulinastatin treatment group were significantly different from those of the control group （Hc=l14.58,45.93,P〈0.05）. The CD^4＋CD^25＋ ratio and serum IL-10 level of the ulinastatin treatment group on the third day were significantly higher than those on the first and fifth day （t=lO.57,6.43,3.73,5.08,P〈0.05）. The CD^4＋CD^25＋/CD^4＋ ratio of the ulinastatin treatment group was significantly lower than that of control group on the third day,and the CD^4＋CD^25＋ ratio and serum IL-10 level of the ufinastatin treatment group were significantly lower than those of control group on the fifth day（t=2.38,7.97,5.79,P〈0.05）. Conclusion Ulinastatin inhibit the increasing of the CD^4＋CD^25＋ regulatory T cells percentage and IL-10 in sepsis patients,thereby avoiding the emergence of immunoparalysis and lowering the mortality.