乌司他丁联合常规集束化治疗对重症脓毒症患者细胞免疫功能的影响  

Effects of Ulinastatin and Routine Bundle Treatment on Cellular Immunity in Patients with Severe Sepsis

作　　者：潘丽萍[1] 慈光胜 邵振华[1] 

机构地区：[1]复旦大学附属华山医院静安分院综合ICU,上海200040

出　　处：《医学综述》2016年第2期344-346,共3页Medical Recapitulate

摘　　要：目的探究乌司他丁联合常规集束化治疗对重症脓毒症患者细胞免疫功能的影响。方法选取2013年1月至2014年12月入住复旦大学华山医院静安分院综合ICU的96例重症脓毒症成年患者,按随机数字表法将其均分为常规治疗组(48例,常规集束化治疗)及乌司他丁组(48例,每日3次乌司他丁40万U静脉滴注联合常规集束化治疗),另选取24例健康体检者作为对照组。分别抽取患者入住ICU当日与治疗4 d后的外周血,检测调节性T细胞(Treg),辅助性T细胞(Th)17及单核白细胞抗原DR等位基因(HLA-DR)表达情况。结果重症脓毒症患者Treg、Th17、Treg/Th17比值显著高于对照组[(12.48±2.69)%比(4.62±0.58)%,(4.99±0.89)%比(2.36±0.39)%,2.97±0.58比2.01±0.52],而HLA-DR表达率显著低于对照组[(27.65±9.06)%比(76.02±11.76)%],差异有统计学意义(P<0.01)。治疗后乌司他丁组的Treg、Th17、Treg/Th17比值显著低于常规治疗组[(7.62±0.58)%比(11.11±1.60)%,(3.32±0.58)%比(4.16±0.65)%,2.36±0.43比2.79±0.30],且HLA-DR表达率显著高于常规治疗组[(57.22±15.75)%比(37.53±13.01)%],差异有统计学意义(P<0.01)。结论乌司他丁可降低重症脓毒症患者Treg、Th17表达率,调节Treg/Th17比值,提高HLA-DR表达率,改善患者细胞免疫及预后。Objective To analyze the effects of ulinastatin and routine bundle treatment on cellular immunity in patients with severe sepsis. Methods Ninety-six patients with severe sepsis in ICU in Huashan Hospital ~ingan Branch Affiliated to Fudan University were chosen from Jan. 2013 to Dec. 2014 and were divided into routine treatment group （48 patients were offered routine bundle treatment） and ulinastatin group（48 patients were offered both routine bundle treatment and 400 000 U ulinastatin mainline three times per day）. Twenty-four healthy individuals served as control group. The expression data of regulatory T cell （Treg） ,helper T cell （Th） 17 and HLA-DR of the two groups were collected on the first day in ICU and 4 days after proper treatments. Results The expressions of Treg,Thl7 and Treg/Th17 rate of the severe sepsis patients were significantly higher than the control group [ （ 12. 48±2.69） % vs （4.62±0. 58） %, （4.99±0.89） % vs （2. 36±0.39）% ,2.97±0.58 vs 2.01±0.52, P 〈 0.01 ] , while the expression of HLA-DR was significantly lower than the control group [ （ 27.65±9.06 ） % vs （ 76.22±11.76 ）%], the difference was statistically significant（ P 〈 0. 01 ）. After treatment, the Treg, Thl7 and Treg/Thl7 expressions rate of ulinastatin group were significantly higher than the routine treatment group [（7.62±0. 58% vs （ 11.11± 1.60） %, （3.32±0. 58 ） % vs （4. 16±0. 65 ） % ,2.36±0. 43 vs 2.79±0. 30 ] , the expression of HLA-DR was significantly lower than the routine treatment group [ （57.22±15.75 ）% vs （37.53±13.01 ）% ], the difference was statistically significant （ P 〈 0. 01 ）. Conclusion Ulinastatin can decease the expressions of Treg and Th17, change Treg/Th17 rate and increase the expression of HLA-DR, thus improve the cellular immunity and prognosis of patients with severe sepsis.

关 键 词：重症脓毒症 乌司他丁 免疫状态 

分 类 号：R453.9[医药卫生—治疗学]