胸腺法新治疗对MICU脓毒症后PICS老年患者免疫、代谢功能的影响

Effect of Thymalfasin Therapy on Immune and Metabolic Functions of Elderly PICS Patients after MICU Sepsis

目的:探讨胸腺法新治疗对内科重症监护病房(MICU)脓毒症后持续性炎症-免疫抑制-分解代谢综合征(PICS)老年患者免疫、代谢功能的影响。方法:选取本院MICU自2017年1月-2020年1月收治的70例脓毒症打击后发生PICS的老年患者进行研究。根据患者意愿将其分为观察组和对照组,每组35例。对照组行常规综合性治疗,观察组在对照组基础上接受胸腺法新治疗。观察两组患者治疗前后各检测指标的变化情况,分析胸腺法新对患者免疫功能及代谢功能的影响;同时对两组患者28、90、120 d内死亡情况进行比较,分析胸腺法新治疗对患者预后的影响。结果:治疗前,两组患者白细胞、淋巴细胞、中性粒细胞、单核细胞、CRP、前白蛋白、白蛋白、转铁蛋白比较,差异均无统计学意义(P>0.05);治疗2周后,两组患者各指标均有一定改变,但组间比较除单核细胞外,其余各指标水平比较,差异均无统计学意义(P>0.05)。治疗前,两组患者外周血流式细胞学各指标水平检测结果比较,差异均无统计学意义(P>0.05)。治疗后,观察组CD4^(+)/CD8^(+)、HLADR/CD14^(+)水平均高于对照组,差异均有统计学意义(P<0.05);但两组T细胞、Th、Treg、B细胞个数比较,差异均无统计学意义(P>0.05)。观察组患者28、90、120 d内死亡率均略低于对照组,但组间比较,差异均无统计学意义(P>0.05)。结论:胸腺法新治疗对改善MICU脓毒症后PICS老年患者免疫功能有一定积极作用,但对患者代谢功能及预后的影响仍需开展更深入的研究。

Objective:To investigate the effect of Thymalfasin therapy on immune and metabolic functions of elderly patients with persistent inflammation-immunosuppression-catabolic syndrome(PICS)after sepsis in elderly medical intensive care unit(MICU).Method:A total of 70 elderly patients with PICS after sepsis attack admitted by our hospital MICU from January 2017 to January 2020 were selected for study.Patients were divided into observation group and control group according to their wishes,35 patients in each group.The control group received conventional comprehensive treatment,and the observation group received Thymalfasin treatment on the basis of the control group.The changes of detection indexes before and after treatment in two groups were observed,and the influence of Thymalfasin on immune function and metabolic function was analyzed.meanwhile,the death situation within 28,90 and 120 days between the two groups were compared,and the influence of Thymalfasin treatment on the prognosis of patients was analyzed.Result:Before treatment,there were no statistically significant differences in white blood cells,lymphocytes,neutrophils,monocytes,CRP,prealbumin,albumin,and transferrin between the two groups(P>0.05).After 2 weeks of treatment,there were certain changes in all indicators between the two groups,but there were no statistically significant differences in the levels of all indicators except monocytes between the two groups(P>0.05).Before treatment,there were no statistically significant difference between the two groups in the detection results of peripheral blood flow cytology indicators(P>0.05).After treatment,the levels of CD4^(+)/CD8^(+)and HLADR/CD14^(+)in the observation group were all higher than those in the control group,with statistically significant differences(P<0.05).However,the number of T cells,Th cells,Treg cells and B cells in the two groups showed no statistically significant differences(P>0.05).The mortality of patients in the observation group within 28,90 and 120 days were slightly lower than those of the control group,but there were no statistically significant differences between the two groups(P>0.05).Conclusion:Thymalfasin therapy has a positive effect on improving immune function in patients with MICU sepsis after PICS,but the effects on metabolic function and prognosis of patients still need to be further studied.