乌司他丁对严重脓毒症患者炎症免疫失衡的调理作用  

The effect of ulinastatin on disbalance of inflammation and immune status in patients with severe sepsis

作　　者：吴铁军[1] 张丽娜[1] 亢翠翠[1] 

机构地区：[1]聊城市人民医院ICU,山东252000

出　　处：《中华危重病急救医学》2013年第4期219-223,共5页Chinese Critical Care Medicine

基　　金：山东省科技发展计划项目（2012YD18024）;山东省聊城市科学技术攻关项目（2011002）;天普研究基金项目（01201121）

摘　　要：目的观察乌司他丁（UTI）对严重脓毒症患者免疫调节细胞、炎症介质及CD14＋单核细胞人自细胞DR抗原（HLA—DR）表达的影响。方法选择2011年10月至2012年10月人住本院重症监护病房（ICU）的严重脓毒症患者60例，按抽签法分为常规治疗组（30例，给予常规集束化治疗）及UTI组（30例，在常规治疗的基础上加用UT1300kU静脉滴注，每日3次），两组均以5d为1个疗程。于治疗前和治疗5d后抽取外周血，检测CD4＋CD25＋调节性T细胞（Treg）、辅助性T细胞17（Th17）、白细胞介素（IL-17、IL-6、IL-10）及HLA—DR的表达情况，观察UTI的干预作用。结果两组患者治疗前各指标比较均无明显差异。与常规治疗相比，UTI能更有效地降低严重脓毒症患者Treg和Th17的表达[Treg：（9．05±1．27）％比（11．83±1．30）％，Th17：（3．20±0．33）％比（4．42±0．35）％，均P〈0．01]；降低Treg／Th17比值，使其趋于正常化（2．22±0．28比2．82±0．29，P〈0．01）；更有效地降低炎症介质IL-17、IL-6、IL-10（均ng／L）的表达（IL-17：98．35±12．23比118．20±15．97，IL-6：24．17±6．72比29．27±8．13，IL-10：33．17±7．24比37．34±8．49，P〈0．05或P〈0．01）；在更大程度上改善细胞免疫状态，使HLA—DR表达升高[（49．34±11．34）％比（36．44±8．14）％，P〈0．01]。UTI组28d病死率较常规对照组有下降趋势，但差异无统计学意义（18．2％比20．1％，P〉0．05）。结论UTI可有效降低严重脓毒症患者Treg及Th17的表达，逆转Treg／rh17失衡，下调IL-17、IL-6、IL-10水平，改善细胞免疫，提高HLA—DR表达，有望改善严重脓毒症患者的预后。Objective To investigate the effect of ulinastatin （UT1） on the levels of immune regulatory ceils, pro-inflammatory mediators, and the expression of human leukocyte antigen-DR （HLA-DR） in CD14＋ monocytes. Methods A total of sixty patients with severe sepsis who were admined to intensive care unit （ICU） during October 2011 to October 2012 were enrolled. The patients were randomly divided into two groups ： routine treatment group （ n= 30, received routine bundle treatment） and UTI group （n =30, received 30 kU UTI three times per day in addition to routine bundle treatment）. A course of treatment consisted of 5 days in both groups. The peripheral blood was collected, and the expression of CD4＋CD25＋ regulatory T cell （Treg）, help T cell 17 （Th17）, intedeukin （IL-17, IL-6, IL-IO） and HLA-DR were determined before and 5 days after treatment, in order to observe the effect of UTI. Results There was no significant difference in all indexes before treatment between two groups. Compared with routine treatment group, UTI could reduce the abnormal expression of Treg and Thl7 in patients with severe sepsis [Treg： （9.05 ± 1.27 ）% vs. （ 11.83 ± 1.30）%, Th17：（3.20 ± 0.33）% vs. （4.42 ± 0.35）%, both P〈0.01], and decrease the ratio of Treg/Th17 （2.22 ± 0.28 vs. 2.82 ± 0.29, P〈0.01 ） more effectively. UTI could also reduce the abnormal expression of IL-17, IL-6 and IL-10 （all ng/L） compared with routine treatment group （IL-17：98.35 ± 12.23 vs. 118.20 ± 15.97, IL-6： 24.17 ± 6.72 vs. 29.27 ± 8.13, IL-10：33.17 ± 7.24 vs. 37.34 ± 8.49, P〈0.05 or P〈0.01）. In addition UTI could ameliorate the immune status, improve the expression of HLA-DR compared with routine treatment group [ （49.34 ± 11.34）% vs. （ 36.44 ± 8.14 ）%, P〈0.01 ]. The 28-day mortality in UTI group showed a tendency of lowering compared with routine treatment group, but the difference between two groups was not significant （ 18.2% vs. 20.1%, P〉0.05 ）. Conclusion

关 键 词：严重脓毒症 辅助性T细胞17 调节性T细胞 细胞免疫 乌司他丁 

分 类 号：R45[医药卫生—治疗学]