左西孟旦联合高容量血液滤过对脓毒症心肌损伤患者免疫功能的影响

Effects of levosimendan combined with high volume hemofiltration on immune function of patients with sepsis related myocardial injury

目的观察左西孟旦联合高容量血液滤过(HVHF)对脓毒症心肌损伤患者免疫功能的影响。方法将2016年1月至2019年1月收治的脓毒症心肌损伤患者60例纳入研究范围,随机分为对照组和治疗组,每组30例。对照组实施早期HVHF治疗,治疗组在对照组基础上加用左西孟旦注射液。比较2组调节性T细胞(Treg)/辅助性T细胞17(Th17)及相关细胞因子[白介素6(IL-6)、IL-10、IL-17]、Th1/Th2及相关细胞因子[γ干扰素(IFN-γ)、IL-4]和转录因子(T-bet、GATA3)、T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)、免疫球蛋白(IgA、IgG、IgM)。结果2组治疗前Treg、Th17、Treg/Th17、IL-6、IL-10、IL-17、Th1、Th2、Th1/Th2、IFN-γ、IL-4、T-bet mRNA、GATA3 mRNA、T-bet/GATA3、CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、IgA、IgG、IgM比较差异无统计学意义(P>0.05);2组治疗后Treg、Th17、Treg/Th17、IL-6、IL-17、Th1、Th1/Th2、IFN-γ、T-bet mRNA、T-bet/GATA3、CD8^+均较治疗前显著降低,IL-10、Th2、IL-4、GATA3 mRNA、CD3^+、CD4^+、CD4^+/CD8^+、IgA、IgG、IgM均较治疗前显著升高(P<0.05),且治疗组改善程度更明显(P<0.05)。结论左西孟旦联合HVHF治疗脓毒症心肌损伤能够有效调节Treg/Th17、Th1/Th2水平,改善细胞免疫和体液免疫功能。

Objective To investigate the effects of levosimendan combined with high volume hemofiltration(HVHF)on immune function in patients with sepsis related myocardial injury.Methods A total of 60 patients with sepsis related myocardial injury who were admitted and treated in our hospital from January 2016 to January 2019 were enrolled in the study,who were randomly divided into observation group(n=30)and control group(n=30).The patients in control group were treated by HVHF,however,the patients in observation group,on the basis of control group,were treated by levosimendan injection.The changes of Treg/Th17 and related cytokines(IL-6,IL-10 and IL-17),Th1/Th2 and related cytokines including IFN-γand IL-4,and transcription factors(T-bet and GATA3),T lymphocytes subsets(CD3^+,CD4^+,CD8^+ and CD4^+/CD8^+)and immunoglobulin including IgA,IgG and IgM were observed and compared between the two groups.Results Before treatment,there were no significant differences in the levels of Treg,Th17,Treg/Th17,IL-6,IL-10,IL-17,Th1,Th2,Th1/Th2,IFN-γ,IL-4,T-bet mRNA,GATA3 mRNA,T-bet/GATA3,CD3^+,CD4^+,CD8^+,CD4^+/CD8^+,IgA,IgG and IgM between the two groups(P>0.05).After treatment,the levels of Treg,Th17,Treg/Th17,IL-6,IL-17,Th1,Th1/Th2,IFN-γ,T-bet mRNA,T-bet/GATA3 and CD8^+ in both groups were significantly decreased,as compared with those those before treatment,however,and the levels of IL-10,Th2,IL-4,GATA3 mRNA,CD3^+,CD4^+,CD4^+/CD8^+,IgA,IgG and IgM were significantly increased in both groups(P<0.05).Moreover the changes of above indexes in observation group were more significant than those in control group(P<0.05).Conclusion Levosimendan combined with HVHF in treatment of sepsis related myocardial injury can effectively regulate the levels of Treg/Th17 and Th1/Th2,and can improve the cellular immunity and humoral immune function of patients.