小牛脾提取物注射液对MODS患者免疫功能的影响  

Effects of calf spleen extractive injection on immunity in patients with multiple organ dysfunction syndrome

作　　者：曾凡军[1,2] 董长垣[1] 龚正[2] 

机构地区：[1]武汉大学基础医学院,湖北武汉430071 [2]三峡大学第一临床医学院宜昌市中心人民医院,湖北宜昌443000

出　　处：《广州医学院学报》2013年第4期5-9,共5页Academic Journal of Guangzhou Medical College

摘　　要：目的:研究小牛脾提取物注射液对多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者的疗效和作用机制。方法:采用随机、对照、单盲的设计方案,三峡大学第一临床医学院48例MODS患者随机分为用药组(24例)和对照组(24例)。对照组常规治疗,用药组常规治疗联合小牛脾提取物注射液治疗(每次10mL,每日1次),疗程7d。观察两组治疗前后淋巴细胞亚群比例、淋巴细胞核因子(nuclear factor,NF)κB的主要亚基P65蛋白的表达,血浆细胞因子浓度的变化。结果:用药组患者发热时间,机械通气时间低于对照组(P<0.05)。用药组淋巴细胞亚群比例较治疗前明显升高(P<0.05),对照组无显著变化(P>0.05)。两组患者细胞因子浓度较用药前明显下降(P<0.05),但用药组细胞因子浓度下降较对照组更为显著(P<0.05)。两组患者淋巴细胞的主要亚基P65蛋白表达均下降,第7天用药组NF-κB P65蛋白表达较对照组低(P<0.05)。回归分析提示CD4^+T细胞百分比、CD4^+/CD8^+、IL-1、IL-6、TNF-α浓度是预测死亡的危险因素,其中CD4^+/CD8^+对预后影响最大。结论:小牛脾提取物注射液可改善免疫功能及生存质量。其机制可能为调控淋巴细胞NF-κB的表达,阻断细胞因子瀑布。Objective： To elucidate the effects and mechanisms of calf spleen extractive injection on immunity in patients with multiple organ dysfunction syndrome （ MODS ）. Methods： In a randomized, single- blind and controlled trial, 48 patients with MODS who were admitted to The First Clinical School, Sanxia University were randomly allocated to be treated with regular treatment （ control group, n = 24 ） or in combination with calf spleen extractive injection lOml once daily for 7 days （ injection medicine group, n = 24）. The proportion of lymphocyte subsets and the expression of 1o65 subunit of nuclear factor-KB （NF-KB） and plasma cytokine concentrations were analyzed. Results： Injection medicine group was characterized by shortened course of fever and mechanical ventilation compared with control group （ both P 〈 0.05 ）. Treatment with calf spleen extractive injection, but not control group, resuhed in markedly increased proportion of lymphocyte subsets （ P 〈 0.05 ）. Cytokine concentration, particularly in injection treatment group, was significantly reduced （ P 〈 O. 05 ）. Both groups yielded attenuated p65 expression in lymphocytes. Injection treatment group was associated with a more considerable decrease in 1o65 expression at day 7 compared with control group （ P 〈 0.05 ）. Logistic regression analysis showed that the CD4＋ T-cells percentage and concentrations of IL-1, IL-6 and TNF-c＋, particularly for the CD4 ＋/CD8 ＋ ratio, were risk factors of mortality. Conclusion： Calf spleen extractive injectionimproves quality of life and immunity possibly via modulation of NF-KB signaling in lymphoeytes that blocks cascades of inflammatory cytokines.

关 键 词：小牛脾提取物注射液 多器官功能障碍综合征 免疫治疗 

分 类 号：R459.9[医药卫生—治疗学]