脓毒症患者辅助性T细胞17和CD4^＋CD25^＋调节性T细胞表达及血必净注射液的干预作用  

Effect of Xuebijing injection （血必净注射液） on T helper 17 and CD4^＋CD25^＋ regulatory T cells in patients with sepsis

作　　者：邵敏[1] 刘宝[1] 王锦权[1] 陶晓根[1] 周树生[1] 金魁[1] 张翠萍[2] 

机构地区：[1]安徽医科大学附属省立医院ICU,合肥230001 [2]安徽医科大学附属省立医院中心实验室,合肥230001

出　　处：《中国危重病急救医学》2011年第7期430-434,共5页Chinese Critical Care Medicine

基　　金：基金项目：安徽省自然科学研究项目（KJ20112203）;安徽省医药卫生课题（09A079）

摘　　要：目的观察脓毒症患者外周血辅助性T细胞17（Thl7）及CD4^＋CD25^＋调节性T细胞（Treg）的水平，并探讨其意义及血必净注射液的干预作用。方法①将64例重症监护病房（ICU）脓毒症患者按疾病严重程度分为脓毒症组（26例）、严重脓毒症组（21例）、脓毒性休克组（17例），同时选取18例健康体检者作为对照组。观察不同严重程度脓毒症患者外周血Thl7和CD4^＋CD25^＋Treg的表达及其与病情严重程度的关系。②按随机原则将64例患者分为常规治疗组（25例，给予常规集束化治疗）和血必净治疗组（39例，在常规治疗基础上加用血必净注射液50ml静脉滴注，每日2次），两组均以7d为1个疗程。入ICU当日和治疗7d用流式细胞术检测外周血Thl7及CD4^＋CD25^＋Treg表达，观察血必净注射液的干预作用。结果①健康对照组Thl7表达率为（O．84±0．29）％，CD4^＋CD25^＋Treg表达率为（O．43±0．20）％；脓毒症患者细胞表达均较健康对照组明显升高（均P〈0．05），其中Thl7表达以严重脓毒症组最高[（3．18±0．84）％]，CD4^＋CD25^＋Treg表达以脓毒性休克组最高[（3．28±0．76）％]。脓毒症患者CD4^＋CD25^＋Treg与急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和血乳酸均呈正相关（r1＝0．519，r2＝0．451，均P＝0．01）。②与常规治疗组比较，血必净注射液能更有效降低脓毒症患者Thl7和CD4^＋CD25^＋Treg的异常表达CThl7：（1．72±0．69）％比（2．35±0．81）％，CD4^＋CD25^＋Treg：（1．78±1．00）％比（2．300．85）％，均P〈0．053，纠正免疫平衡紊乱，缩短住ICU时间[（4．7±2．6）d比（7．5±4．3）d，P＝0．0023，使脓毒症患者28d病死率有降低趋势（20．5％比28．0％，P〉0．05）。结论脓毒症患者外周血Thl7和CD4^＋CD25^＋Treg表达增加，且与病情严重程度呈正相关，提示Thl7和CD4^＋CD25^＋Treg�Objective To study the level and significance of T helper 17 （Thl7） and CD4~CD25＋ regulatory T cells （Treg） in peripheral blood of patients with sepsis and to evaluate the effects of Xuebijing injection（血必净注射液） on them. Methods （1）Sixty-four patients with sepsis in intensive care unit （ICU） of Anhui Provincial Hospital were divided into three groups： sepsis group （n = 26）, severe sepsis group （n=21）, and septic shock group （n= 17）. Eighteen healthy individuals served as controls. The comparison in the expression of Th17 and CD4＋CD25＋ Treg within groups and the correlation between their levels and the severity of sepsis was made. （2） Sixty-four patients were also randomly divided into two groups： routine group （n= 25, received routine bundle treatment） and Xuebijing treatment group （n= 39, received bundle treatment ＋ Xuebijing treatment）. Patients in Xuebijing treated group were given 50 ml Xuebijing injection two times per day in addition to routine bundle treatment. Seven days constituted one course of treatment. The expressions of Thl7 and CD4^＋CD25^＋ Treg of 64 patients on the 1 day and 7 days after treatment were detected by flow cytometry. The effects of Xuebijing injection on the patients were evaluated. Results （1）The expression rate of Thl7 and CD4^＋CD25^＋ Treg was （0.84± 0.29）% and （0.43±0.20）% respectively in control group, and they were lower than that of patients with sepsis （P〈0. 05）. The expression rate of Thl7 was higher in severe sepsis group [（3.18±0.84）%] than that of other two groups （P〈0.05）. Moreover, The expression rate of CD4^＋ CD25^＋ Treg was highest [（3.28±0.76）%] in septic shock group （P〈0. 05）, and it was positive correlated with acute physiology and chronic health evaluation II （APACHE it ） score and blood lactate （r1=0. 519, r2=0. 451, both P=0.0l） in all 64 patients. （2）Compared with routine group, our study indicated that Xuebijing injection could re

关 键 词：脓毒症 免疫平衡 辅助性T细胞17 CD4^+CD25^+调节性T细胞 血必净注射液 

分 类 号：R459.7[医药卫生—急诊医学]