乌司他丁对重症脓毒症患者Treg/Th17的影响  

Effects of Ulinastatin on Treg/Th17 in Patients with Severe Sepsis

作　　者：吴铁军[1] 张丽娜[1] 亢翠翠[1] 

机构地区：[1]聊城市人民医院重症医学科,山东聊城252000

出　　处：《中国呼吸与危重监护杂志》2013年第3期240-243,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：天普研究基金(编号:01201121)

摘　　要：目的观察乌司他丁对重症脓毒症患者Treg/Th17平衡状态及细胞免疫状态的影响。方法选择2011年10月至2012年7月入住聊城市人民医院综合重症加强治疗病房(ICU)的重症脓毒症患者80例,随机分为常规治疗组(40例,给予常规集束化治疗)及乌司他丁组(40例,在常规集束化治疗基础上加用乌司他丁30万U静脉滴注,每日3次)。入ICU当日和治疗5 d后抽取患者外周血,检测Treg、Th17及CD14单核细胞HLA-DR的表达情况,并比较两组患者28 d死亡率。同时选取20名健康体检者作为对照组。结果重症脓毒症患者Treg、Th17的表达均较对照组明显升高(P<0.01),Treg/Th17升高(P<0.01),HLA-DR表达降低(P<0.01),提示重症脓毒症患者抗炎反应更强烈,体内出现免疫麻痹。重症脓毒症患者中,乌司他丁组与常规治疗组治疗前各指标无明显差异(P>0.05),治疗后乌司他丁组Treg和Th17的表达显著降低(P<0.01),Treg/Th17比值降低趋于正常化(P<0.01),HLA-DR的表达显著升高(P<0.01),28 d死亡率有下降趋势。结论重症脓毒症患者中Treg及Th17表达异常升高,Treg/Th17失衡,HLA-DR表达降低,提示患者体内存在免疫麻痹。乌司他丁可降低重症脓毒症患者Treg及Th17表达,逆转Treg/Th17失衡,提高HLA-DR表达,改善细胞免疫,有望改善重症脓毒症患者预后。Objective To investigate the effects of ulinastatin on Treg/Th17 and immune status in patients with severe sepsis. Methods A total of 80 patients with severe sepsis,who were hospitalized in ICU during October 2011 to July 2012, were randomly divided into a routine group and a ulinastatin group. The patients in the ulinastatin group were intravenously administered 30mg ulinastatin three times per day for 5 days in addition to routine bundle treatment. The expression of Treg,Th17 and HLA-DR were detected on the first day in ICU and 5 days after treatment. 20 healthy individuals served as controls. Results Compared with the control group, the severe sepsis group had overexpression of Treg and Th17 （P 〈 0. 01 ）, higher ratio of Treg,/Th17（P 〈0. 01 ） ,and decreased HLA-DR expression of CD14 monocyte （P 〈0. 01 ）. In the severe sepsis patients, ulinastatin injection reduced the abnormal expression of Treg and Th17 （ P 〈 0. 01 ）, decreased the ratio of Treg/Th17 （ P 〈 0.01 ） , and improved the expression of HLA-DR （ P 〈 0.01 ） more effectively compared with the routine treatment. Ulinastatin also lowered 28-day mortality of the patients with sepsis, but the difference between the ulinastatin group and the routine group was not significant. Conclusions In severe sepsis patients,there were abnormal overexpression of Treg and Th17 ,imbalance of Treg/Th17, and underexpression of HLA-DR which imply an immune suppression. Ulinastatin can decrease the expression of Treg and Th17, inverses the ratio of Treg/Th17, and improve the expression of HLA-DR, so as to improve the prognosis of severe sepsis patients.

关 键 词：重症脓毒症 乌司他丁 TH17 调节性T细胞 细胞免疫 

分 类 号：R459.7[医药卫生—急诊医学]