参附注射液联合低剂量氢化可的松对重度脓毒血症患者血浆HLA-DR和PCT水平的影响  

Effect of Shenfu Injection Combined with Low Dose Hydrocortisone on HLA-DR and PCT in Patients with Severe Sepsis

作　　者：周海丰 戈艳蕾 李红艳[3] 王红阳 

机构地区：[1]玉田县中医医院内二科,河北玉田064100 [2]华北理工大学附属医院呼吸内科,河北唐山063000 [3]唐山市丰南区中医院防保科,河北唐山063300

出　　处：《医学综述》2016年第7期1382-1385,共4页Medical Recapitulate

基　　金：河北省医学科学研究重点课题(ZD20140500)

摘　　要：目的观察参附注射液联合低剂量氢化可的松对重度脓毒症患者血浆单核细胞表面人类白细胞抗原DR位点(HLA-DR)和降钙素原(PCT)水平的影响。方法选择2012年12月至2014年12月华北理工大学附属医院治疗的重度脓毒血症患者98例为研究对象,按随机数字表法分为对照组(32例)、观察1组(33例)和观察2组(33例)。对照组给予常规西医综合治疗,观察1组给予常规西医综合治疗+参附注射液;观察2组给予常规西医综合治疗+参附注射液+低剂量氢化可的松。分别在治疗前、治疗后1 d、3 d、7 d检测外周血单核细胞HLA-DR、PCT水平。比较两组患者7 d内的病死率。结果治疗后7 d对照组死亡19例,观察1组死亡14例,观察2组死亡8例,三组比较差异有统计学意义(P<0.05)。治疗后3 d和7 d,观察1组和观察2组的HLA-DR水平均高于对照组[(20.9±4.1)%、(24.3±5.4)%比(16.8±3.2)%;(21.8±5.3)%、(26.3±6.1)%比(17.8±4.9)%],观察1组和观察2组的PCT水平低于对照组[(14.1±2.3)μg/L、(10.3±2.4)μg/L比(19.0±3.1)μg/L;(10.4±2.4)μg/L、(6.3±2.1)μg/L比(16.8±3.4)μg/L],差异均有统计学意义(P<0.05);观察2组HLA-DR水平高于观察1组,PCT水平低于观察1组,差异有统计学意义(P<0.05)。结论参附注射液联合低剂量氢化可的松可有效地降低PCT水平,提高HLA-DR水平,促进重度脓毒症患者的转归。Objective To explore the effect of Shenfu injection combined with low dose hydrocortisone on human leucocyte antigen（ HLA-DR） and procalcitonin（ PCT） in patients with severe sepsis. Methods Total of 98 severe septic patients admitted to the Affiliated Hospital of North China University of Science and Technology University from Dec. 2012 to Dec. 2014 were divided into three groups： observation 1 group（ 33 cases）,observation 2 group（ 33 cases） and control group（ 32 cases）. The control group received basic treatment,while the observation group 1 received Shenfu injection and the observation 2 group received Shenfu injection combined with low dose hydrocortisone besides basic treatment. The peripheral blood monocyte HLA-DR and PCT were observed before and after 1 d,3 d,7 d of treatment. 7 d mortality of the two groups were compared. Results Altogether 19 cases died in the control group,while 14 cases died in the observation 1 group and 8 died in the observation 2 group after 7 d of treatment（ P 〈 0. 05）. The HLA-DR level in the observation 1 group and observation 2 group were higher than the control group [（ 20. 9 ± 4. 1） %,（ 24. 3 ± 5. 4） % vs（ 16. 8 ± 3. 2） %;（ 21. 8 ± 5. 3） %,（ 26. 3 ± 6. 1） % vs（ 17. 8 ± 4. 9） % ]（ P 〈0. 05）; the HLA-DR level in the observation 2 group was higher than the observation 1 group,the PCT level of the observation 1 group and observation 2 group were lower than the control group[（ 14. 1 ± 2. 3） μg / L,（ 10. 3 ± 2. 4） μg/L vs（ 19. 0 ± 3. 1） μg/L;（ 10. 4 ± 2. 4） μg/L,（ 6. 3 ± 2. 1） μg/L vs（ 16. 8 ±3. 4） μg / L]（ P 〈 0. 05）,the observation 2 group was lower than observation 1 group（ P 〈 0. 05）.Conclusion The combination therapy of Shenfu injection and low dose hydrocortisone can effectively reduce PCT level and increase HLA-DR,improving the prognosis for patients with severe sepsis.

关 键 词：脓毒症 参附注射液 氢化可的松 血单核细胞人类白细胞抗原 降钙素原 

分 类 号：R593.241[医药卫生—内科学]