脓毒症休克患者早期小剂量糖皮质激素治疗对免疫功能的影响

Effect of Early Low-dose Glucocorticoid on Immune Function in Patients with Septic Shock

目的:探讨早期应用小剂量糖皮质激素对脓毒症休克患者免疫功能的影响。方法:选择2016年5月-2017年6月我院脓毒症休克患者70例,随机分为对照组、早期激素治疗组和晚期激素治疗组,所有入选患者均于治疗前及治疗后1d、3d、7d检测外周血CD4^+T淋巴细胞的凋亡率及单核细胞HLA-DR的表达率。结果:(1)对照组、早期激素治疗组和晚期激素治疗组治疗后3d及7d外周血CD4^+T淋巴细胞的凋亡率均较治疗前明显下降,且随着时间的延长,外周血CD4^+细胞的凋亡率明显下降,差异有统计学意义(P<0.05);早期激素治疗组和晚期激素治疗组治疗后3d、7d外周血CD4^+T淋巴细胞的凋亡率均较对照组明显下降,差异有统计学意义(P<0.05);但是早期激素治疗组各时间点外周血CD4^+T淋巴细胞的凋亡率与晚期激素治疗组差异无统计学意义(P>0.05);(2)对照组、早期激素治疗组和晚期激素治疗组治疗后1d、3d及7d外周血单核细胞HLA-DR的表达水平均较治疗前明显上升,且随着时间的延长,外周血单核细胞HLA-DR的表达水平逐渐升高,差异有统计学意义(P<0.05);三组治疗后各时间点外周血单核细胞HLA-DR的表达水平差异均无统计学意义(P>0.05);(3)对照组、早期激素治疗组和晚期激素治疗组住院期间休克复发、心律失常、胃肠道出血、血糖升高(血糖≥10mmol/L)及合并真菌感染的发生率均差异无明显统计学意义。结论:早期应用小剂量糖皮质激素对免疫功能没有明显的抑制作用。

To investigate the effect of early low-glucocorticoid on immune function in patients with septic shock.Methods:70 patients with septic shock who had no reaction to fluid resuscitation and vasoactive drug in our hospital from May 2016 to June 2017 were devided into control group,early-hormone group and late-hormone group.Peripheral blood CD4+cells apoptosis rate,HLA-DR expression were detected by Flow cytometry at pre-therapy,1d,3d and 7d by post-therapy.Results:(1)Peripheral blood CD4+cells apoptosis rate significantly decreased pro-treatment than that of pre-treatment,and gradually decreased with the time,the difference was statistically significant(P<0.05).Comparison between groups,Peripheral blood CD4+cells apoptosis rate was significantly decreased in early hormone group and late hormone group than that of Control group after treatment at 3d and 7d,the difference was statistically significant(P<0.05).Peripheral blood CD4+cells apoptosis rate has no statistical difference between early hormone group and late hormone group after treatment at 3d and 7d(P>0.05).(2)Peripheral blood mononuclear cells HLA-DR level significantly increased pro-treatment than that of pre-treatment,and gradually increased with the time,the difference was statistically significant(P<0.05).Peripheral blood mononuclear cells HLA-DR level has no statistical difference between early hormone group,late hormone group and control group.(3)Shock recurrence in hospital,arrhythmia,gastrointestinal bleeding,blood glucose(blood sugar≥10mmol/L)and the incidence of fungal infection had no significant statistical difference in late-hormone group,control group and early-hormone group.Conclusion:The results show that early low-glucocorticoid is not obviously effected on immune function in patients with septic shock.