黄芪注射液改善老年脓毒症患者免疫功能的临床研究  

A clinical study of improvement of immunologic function in patients with old age sepsis treated by astragalus injection

作　　者：任毅[1] 吴胜喜[1] 尹鑫[1] 郭力恒[1] 张敏州[1] 

机构地区：[1]广东省中医院重症医学科,广东广州510120

出　　处：《中国中西医结合急救杂志》2014年第5期323-327,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省中医药科技计划项目（20121191）;广州中医药大学科研创新基金（11CX022）

摘　　要：目的：评价黄芪注射液对老年脓毒症患者免疫功能的影响和安全性。方法选择广东省中医院重症医学科收治的老年脓毒症患者60例，按随机数字表法分为对照组和治疗组，每组30例。对照组参照2012年脓毒症治疗指南进行治疗，包括给予抗菌药物、机械通气、脏腑功能支持治疗等；治疗组在常规治疗基础上给予250 mL 0.9%生理盐水加入60 mL黄芪注射液（每支10 mL）静脉滴注，每日1次，疗程为7 d。比较两组患者治疗前后免疫学指标、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOFA评分）、机械通气时间、入住重症监护病房（ICU）时间、28 d病死率及药物不良反应等。结果两组治疗前CD3＋、CD3＋CD4＋、CD3＋CD8＋、辅助性T细胞/T抑制性细胞（Th/Ts）比较差异均无统计学意义（均P＞0.05），而对照组CD3-NK＋较治疗组明显升高〔（10.47±6.22）%比（6.26±4.13）%，P＜0.05〕，治疗组治疗后CD3＋、CD3＋CD4＋、CD3-NK＋较治疗前升高，CD3＋CD8＋、Th/Ts较治疗前降低；对照组治疗后CD3＋、CD3＋CD8＋、CD3-NK＋较治疗前降低，CD3＋CD4＋、Th/Ts较治疗前升高，两组治疗后CD3＋、CD3＋CD4＋、CD3＋CD8＋水平比较差异均有统计学意义〔CD3＋：（30.30±17.17）%比（41.91±22.29）%，CD3＋CD4＋：（31.54±13.24）%比（40.08±15.28）%，CD3＋CD8＋：（14.25±8.10〕%比（9.52±9.33）%，均P＜0.05〕，两组Th/Ts比值、CD3-NK＋比较差异无统计学意义（均P＞0.05）。治疗组治疗后免疫球蛋白G（IgG）较对照组明显升高〔IgG（g/L）：13.07±5.43比10.10±3.96，P＜0.05〕，两组IgA、IgM、补体（C3、C4）、补体溶血活性（CH50）治疗前后比较差异均无统计学意义（均P＞0.05）。治疗组与对照组APACHEⅡ评分（分：13.83±6.18比15.90±7.48）、SOFA评分（分：7.38±4.66比6.89±4.19）、入住ICU时间（d：11.63±5.13比ObjectiveTo evaluate the clinical efficacy and safety of astragalus injection on the immune function in patients with senile sepsis.Methods Sixty patients with old age sepsis in Critical Care Medicine Department of Guangdong Provincial Traditional Chinese Medicine Hospital were enrolled and randomly assigned into control and treatment groups according to the table of random numbers, 30 cases in each group. According to 2012 sepsis guidelines for treatment, including antibacterial drug, mechanical ventilation, visceral function support, etc., the therapy was given to the control group; besides the treatment in the control group, intravenous drip of 60 mL astragalus injection（10 mL per ampoule） in 250 mL 0.9% normal saline was additionally given in the treatment group, once a day for 7 days. Before and after treatment, the immunological indexes, acute physiology and chronic health evaluationⅡ（APACHEⅡ） score, sequential organ failure assessment（SOFA） score, duration of mechanical ventilation and time of stay in intensive care unit（ICU）, 28-day mortality and adverse drug reactions were compared between the two groups.Results Before treatment, there were no statistically significant differences in CD3＋, CD3＋CD4＋, CD3＋CD8＋ and T helper cells /T suppressor cells（Th/Ts）levels between the two groups（allP〉0.05）, while CD3-NK＋ of the control group was significantly higher than that in the treatment group〔（10.47±6.22）% vs. （6.26±4.13）%,P〈0.05〕. After treatment in treatment group, CD3＋, CD3＋CD4＋ and CD3-NK＋ were increased, CD3＋CD8＋,Th/Ts were decreased compared with those before treatment; in the control group after treatment, CD3＋,CD3＋CD8＋ and CD3-NK＋ were decreased and CD3＋CD4＋ and Th/Ts increased compared with those before treatment. In the comparisons between the treatment group and control group after treatment, the differences in CD3＋, CD3＋CD4＋ and CD3＋CD8＋ had statistical significance〔CD3＋：（30.30±17.17）% vs.（41.91±

关 键 词：脓毒症 黄芪注射液 细胞免疫 体液免疫 免疫调节 中西医结合疗法 

分 类 号：R572[医药卫生—消化系统]