乌司他丁对重症蝮蛇伤患者免疫功能及炎症因子的影响  

Effect of ulinastatin on cellular immunity and expression of inflammatory factors in patients bitten severely by agkistrodon halys

作　　者：周克兵[1] 姚平波[2] 邓立普[1] 赵红[1] 

机构地区：[1]南华大学附属南华医院急诊科,湖南衡阳421002 [2]南华大学附属南华医院重症监护室,湖南衡阳421002

出　　处：《中国急救医学》2014年第5期392-394,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨乌司他丁对重症蝮蛇伤患者免疫功能和炎症因子的影响。方法90例重症蝮蛇伤患者按照随机化的原则分为对照组和观察组。对照组45例，给予抗蛇毒血清、抗感染，必要时血液透析及对症支持治疗；观察组45例，给予乌司他丁联合常规治疗。两组患者均采用ELISA法检测血清中IL-6和TNF-α含量；检测治疗前及治疗后1、3、5、7d血清CD4＋、CD8＋及CD4＋／CD8‘水平。结果治疗5d后两组血清IL-6、TNF-α含量均较治疗前明显降低（P〈0．05），观察组的变化较对照组明显（P〈0．05）。治疗后两组患者CD4＋、CD8＋及CIM＋／CD8＋均呈升高趋势。治疗5d后两组CD4＋较治疗前明显升高（P〈0．05），观察组较对照组明显升高（P〈0．05）；治疗前后两组内CD4＋／CD8＋比较，差异无统计学意义（P〉0．05），治疗后5d和7d观察组CD4＋／CD8＋较对照组明显升高（P〈0．05）；治疗前后两组CD8＋在组间及组内比较，差异均无统计学意义（P〉0．05）。结论重症蝮蛇伤患者的免疫功能下降，以CD4＋、CD4＋／CD8＋下降为主。使用乌司他丁后能提高CD4＋、CD4＋／CD8＋的水平，改善患者细胞免疫功能，降低患者血清中TNF—α和IL-6含量而促进机体恢复。Objective To investigate effect of ulinastatin on cellular immunity and expression of inflammatory factors in patients bitten severely by agkistrodon halys. Methods Ninety patients with agkistrodon halys bitten severely were randomly divided into edaravone with ulinastatin group （n = 45 ） and conventional therapy group （ control group, n = 45 ）. The levels of plasma TNF - a and IL - 6 were determined by ELISA. The numbers of CD4＋ , CD8＋ and CD4＋/CD8＋ T lymphocytes in peripheral blood were examined with flow cytometry at the 1st, 3rd, 5th and 7th day after the onset. Results On day 5 of the treatment, IL - 6 and TNF - α levels were significantly decreased in two treatment groups compared to basal levels （ P 〈 0. 05 ） ; importantly, there was significant difference in serum marker levels of IL - 6 and TNF - α between ulinastatin group and control group on day 5 of the treatment （ P 〈0. 05 ）. After treatment, The numbers of CD4 ＋ , CD8 ＋ and CD4 ＋/CD8 ＋ T lymphocytes were increased （P 〈 0.05 ）. CD4 ＋ T lymphocytes were significantly increased by the two treatment, and there was significant difference in the numbers of CD4 ~ on day 5 and day 7 between ulinastatin group and control group （P 〈 0.05 ）. Compared with control group, there was significant difference in the numbers of CD4 ＋/CD8 ＋ T lymphocytes on day 5 and day 7 of the treatment （P 〈 0.05 ） ; there were no significant difference in the numbers of CD4＋/CD8＋ T lymphoeytes between before - treatment and after - treatment, between groups and within - groups （ P 〉 0.05 ）. Conclusion The immune function of patients bitten severely by agkistrodon halys was decreased which mainly presented by decreased numbers of CD4＋ and CD4＋/CD8＋ T lymphocytes. Ulinastatin can improve the cellular immune function and decrease the levels of IL - 6 and TNF - α in serum, then promote the recovery of patients.

关 键 词：重症 蝮蛇伤 炎症因子 细胞免疫 乌司他丁 

分 类 号：R285.5[医药卫生—中药学]