参麦注射液联合尿蛋白酶抑制剂对创伤脓毒症患者免疫调理的临床观察

The Immunomodulation by Shenmai Injection and Ulinastatin in Patients with Posttraumatic Sepsis

目的:探讨参麦注射液联合尿蛋白酶抑制剂(乌司他丁)对创伤后脓毒症患者免疫调理治疗作用及其机制。方法:选取60例创伤脓毒症的患者,随机分为治疗组和对照组,每组30例。对照组采用经典SSC常规集束化治疗。治疗组在上述治疗的基础上,加用乌司他丁和参麦注射液联合免疫调理治疗,所有患者于治疗前、治疗第3、7 d采用流式细胞仪检测外周血T淋巴细胞亚群,用酶联免疫吸附法(ELISA)检测患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、IL-6水平,并记录APACHEⅡ评分,观察两组在ICU的治疗时间、MODS发生率、死亡率。结果:两组对比在ICU治疗时间、MODS发生率、死亡率等方面有显著差异,治疗前两组患者CD4^+T细胞、CD4^+/CD8^+均有下降,IL-6,TNF-α水平升高;但两组患者治疗前各指标比较均无明显差异(P>0.05)。治疗后治疗组上述各指标的改善程度明显好于对照组;其中7 d时治疗组CD4^+T细胞(45.15±8.08)、CD4^+/CD8^+比值(1.87±0.62),较对照组CD4^+T细胞(35.96±7.13)、CD4^+/CD8^+比值(1.51±0.38)均升高明显(P<0.05或P<0.01);7 d时治疗组IL-6为(32.95±9.1)pg/mL,TNF-α为(43.15±15.4)pg/mL,APACHEⅡ评分为(10.02±5.21),而对照组IL-6为(60.2±8.05)pg/mL,TNF-α为(82.25±19.85)pg/mL,APACHEⅡ评分为(16.04±6.45),两组比较,治疗组较对照组IL-6、TNF-α水平和APACHEⅡ评分下降更明显(P<0.05或P<0.01)。结论:参麦注射液联合乌司他丁对创伤后脓毒症患者,能抑制炎性因子的释放,减轻炎症反应,改善细胞免疫功能。

Objective To explore whether Shenmai injection combined with Ulinastatin has effects on im-munomodulation in patients with posttraumatic sepsis. Methods Sixty patients with posttraumatic sepsis were randomly divided into treatment group and control group （30 cases in each group）. The control group underwent the conventional treatment for sepsis （surviving sepsis campaign, SSC）.The patients in the treatment group were administered Ulinastatin and Shenmai injection in addition to SSC. The peripheral venous blood samples of all the patients were drawn both before and third and 7th days after treatment. T lymphocyte subgroups were deter-mined in the blood samples by flow cytometry. Serum levels of tumor necrosis factor-α （TNF-α）, interleukin-1 （IL^-1） and IL-6 were determined by ELISA . APACHE II scoring system was used to observe the ICU treatment time, incidence of MODS and mortality rate in the two groups. Results There were significant differences be-tween the two groups in the ICU treatment time, incidence of MODS, and mortality rate. Before treatment, both CD4^＋ T cells and the ratio of CD4^＋/CD8^＋ were significantly decreased in the two groups. At the same time, the levels of IL-6 and TNF-α were increased but there were no significant differences between the two groups （P〉0.05）. After treatment, the above indexes in the treatment group were better than those in the control group. On the 7th day, the CD4^＋T cells and the ratio of CD4^＋/CD8^＋ in treatment group were（45.15±8.08）and（1.87±0.62）, respectively. While the CD4^＋T cells and the ratio of CD4^＋/CD8^＋ in control group were （35.96 ± 7.13）and （1.51 ± 0.38）, respectively. Both the CD4^＋T cells and the ratio of CD4^＋/CD8^＋ in treatment group were in-creased as compared to those in the control group.On the same 7th day, The levels of IL-6 and TNF-αand the APACHE II score in treatment group were（32.95± 9.1） pg/mL、（43.15 ± 15.4） pg/mL and（10.02 ± 5.21）, respectively. While the IL-6 and TNF-α levels and the APACHE II score in the control group were（60.2± 8.05）pg/mL、（82.25±19.85）pg/mL and（16.04±6.45）, re-spectively. The IL-6 and TNF-α levels and the APACHE II score were obviously improved in the treatment group compared with those in the control group. Conclusion Shenmai injection combined with Ulinastatin is of value in the treatment of traumatic sepsis. This strategy can inhibit the release of inflammatory factors, relieve the inflammatory reaction, and improve immune function.