乌司他丁联合持续性血液净化对严重脓毒症患儿细胞免疫失衡、内毒素清除的影响

Effects of ulinastatin combined with continuous blood purification on cellular immune imbalance and endotoxin clearance in children patients with severe sepsis

目的观察乌司他丁联合持续性血液净化(CBP)治疗严重脓毒症患儿疗效及对患儿细胞免疫失衡、内毒素清除的影响。方法选取2016年1月-2019年6月海南省妇女儿童医学中心儿科重症监护室(PICU)收治的脓毒症患儿96例为研究对象,采用随机数字表法分为观察组与对照组各48例,两组均有液体复苏、抗感染、对症支持等常规治疗,对照组给予CBP治疗,观察组在对照组之上加用乌司他丁,连续治疗7 d,观察患儿临床疗效,检测患儿治疗前后辅助性T细胞(Th17)、调节性T细胞(Treg)表达率及Treg/Th17比值以评价细胞免疫平衡状态,检测治疗前后患儿血乳酸、内毒素水平,并计算清除率,记录患儿PICU住院时间、多器官功能障碍发生率、脓毒症休克发生率、28 d病死率。结果治疗7 d后,观察组患儿总有效率89.58%,显著高于对照组的72.92%,差异有统计学意义(P<0.05)。两组患儿治疗前Treg、Th17表达率、Treg/Th17比值、血乳酸、内毒素比较差异无统计学意义(P>0.05)。治疗7 d后,两组患儿血清Treg、Th17表达率、Treg/Th17比值、血乳酸、内毒素水平均显著低于治疗前,差异有统计学意义(P<0.05);且观察组患儿上述指标均显著低于对照组,差异有统计学意义(P<0.05)。观察组患儿血乳酸、内毒素清除率显著高于对照组,差异有统计学意义(P<0.05);观察组患儿PICU住院时间显著短于对照组,多器官功能障碍发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论乌司他丁联合CBP用于严重脓毒症患儿治疗,能提高患儿临床疗效、改善细胞免疫失衡状态、促进血乳酸及内毒素清除,有利于缩短患儿PICU住院时间、降低多器官功能衰竭发生率。

Objective To observe the efficacy of ulinastatin combined with continuous blood purification(CBP)on children patients with severe sepsis and its effects on cellular immune imbalance and endotoxin clearance.Methods A total of 96 children patients with sepsis in the pediatric intensive care unit(PICU)from January 2016 to June 2019 were selected from Hainan Women and Children’s Medical Center.They were divided into observation group and control group according tothe random number table method,with 48 cases in each group.The two groups were given routine treatment such as fluidresuscitation,anti-infection and symptomatic support,and control group was given CBP,and observation group wasadditionally given ulinastatin on the basis of control group,and they were continuously treated for 7 d.The clinical efficacywas observed,and the expression rates of helper T cell(Th17)and regulatory T cell(Treg)and Treg/Th17 ratio weredetected before and after treatment to evaluate the cellular immune balance,and the levels of blood lactate and endotoxinwere detected before and after treatment,and the clearance rate was calculated,and the PICU stay,incidence rate ofmultiple organ dysfunction syndrome,incidence rate of septic shock and 28 d mortality rate were recorded.Results After7 d of treatment,the total effective rate in observation group was significantly higher than that in control group(89.58%vs.72.92%)(P<0.05).Before treatment,there were no significant differences in the expression rates of Treg and Th17,Treg/Th17 ratio and levels of blood lactate and endotoxin between the two groups(P>0.05).After 7 d of treatment,the expressionrates of serum Treg and Th17,Treg/Th17 ratio and levels of blood lactate and endotoxin in the two groups were significantlylower than those before treatment(P<0.05),and the above indexes in observation group were significantly lower than thosein control group(P<0.05).The blood lactate and endotoxin clearance rate in observation group were significantly higher thanthose in control group(P<0.05).The PICU stay in observation group was significantly shorter than that in control group(P<0.05),and the incidence rate of multiple organ dysfunction syndrome was significantly lower than that in control group(P<0.05).Conclusion Ulinastatin combined with CBP for children patients with severe sepsis could improve the clinicalefficacy and cellular immune imbalance,promote blood lactate and endotoxin clearance,and help shorten the PICU stayand reduce incidence rate of multiple organ failure.