丙种球蛋白冲击治疗重症社区获得性肺炎的疗效及对患者血清免疫蛋白和淋巴细胞亚群的影响

Effect of gamma globulin pulse therapy on patients with severe community-acquired pneumonia and on serum immune proteins and lymphocyte subsets

目的探究丙种球蛋白冲击治疗重症社区获得性肺炎(severe community acquired pneumonia,SCAP)的疗效,对患者临床症状的改善以及血清免疫蛋白和淋巴细胞亚群水平的影响。方法选取2017年1月—2020年1月于金华市中心医院接受治疗的100例SCAP患者,采用随机数字表法分为观察组和对照组,各50例。对照组患者予以对症干预治疗。观察组加用丙种球蛋白。治疗7 d后比较2组患者疗效。治疗前后记录患者氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SpO_(2))、血清超敏C反应蛋白(hsCRP)、降钙素原(PCT)水平以及急性生理与慢性健康状况(APACHEⅡ)评分,测定血清免疫球蛋白G/A/M(IgG/A/M)、补体以及淋巴细胞亚群比例。结果观察组总有效率(94.00%)高于对照组(80.00%,χ^(2)=4.332,P=0.037);治疗后2组患者PaO_(2)、SpO_(2)均较同组治疗前升高,且观察组均高于对照组,PaCO_(2)、hsCRP、PCT水平以及APACHEⅡ评分均较治疗前降低,且观察组均低于对照组(均P<0.05);治疗后观察组IgG水平较同组治疗前升高,且高于对照组(P<0.05);治疗后观察组CD4+、CD4+/CD8+均较治疗前升高,且观察组均高于对照组,CD8+较治疗前降低,且观察组低于对照组(均P<0.05)。结论丙种球蛋白冲击治疗SCAP可改善患者免疫系统功能和淋巴细胞亚群比例,疗效较好。

Objective To explore the efficacy of gamma globulin pulse therapy in treating severe community-acquired pneumonia(SCAP),improving clinical symptoms and influencing the levels of serum immune protein and lymphocyte subsets.Methods A total of 100 patients with SCAP who were treated in Jinhua Central Hospital of Zhejiang Province from January 2017 to January 2020 were randomly divided into the observation group(50 cases)and control group(50 cases)by using the random number table.The control group was given symptomatic intervention,whilst the observation group received intravenous infusion of gamma globulin on the basis of the control group.After 7 days of treatment,the efficacy of the two groups was compared.Before and after treatment,the patients’partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),percutaneous oxygen saturation(SpO_(2)),serum high-sensitivity C-reactive protein(hsCRP),procalcitonin(PCT)levels,and acute physiology and chronic health evaluation(APACHEⅡ)score were recorded.The serum immunoglobulin G/A/M(IgG/A/M),complement levels and lymphocyte subset ratio were measured.Results The total effective rate in the observation group(94.00%)was higher than that in the control group(80.00%,χ^(2)=4.332,P=0.037).Moreover,the PaO_(2)and SpO_(2)of both groups after treatment were higher than those before treatment,and the values were higher in the observation group compared with the control group.The levels of PaCO_(2),hsCRP,PCT and APACHEⅡscore were lower after treatment than before treatment,and they were lower in the observation group than in the control group(all P<0.05).The IgG level of the observation group after treatment was higher than that before treatment,and the observation group had higher IgG level than the control group(P<0.05).Moreover,the concentrations of CD4+and CD4+/CD8+in the observation group were higher after treatment than before treatment,and the observation group had higher concentrations than the control group.Meanwhile,the concentration of CD8+was lower after treatment than before treatment,and the observation group had lower concentration than the control group(all P<0.05).Conclusion Gamma globulin pulse therapy can improve the immune system function and lymphocyte subset ratio of patients with SCAP.