胸腺肽对严重脓毒症患者的免疫调理和临床应用意义  

Effect of thymosina α1 on the cellular immunity and clinical therapy in patients with severe sepsis

作　　者：程园园[1] 吴晓琴[1] 刘宗师[1] 

机构地区：[1]广州市第一人民医院老年病科,广州510180

出　　处：《临床医学》2016年第12期10-12,共3页Clinical Medicine

摘　　要：目的探讨严重脓毒症患者接受免疫调理治疗后的病情转归和胸腺肽α1对机体细胞免疫的影响。方法选择2012年5月至2014年12月入住重症监护室年龄>18岁、APACHEⅡ评分>10分的严重脓毒症患者73例,随机分为对照组和治疗组。对照组(35例)采取经典ICU治疗,以《拯救脓毒症运动之严重脓毒症及休克治疗指南》为标准;治疗组(38例)除经典治疗外,给予胸腺肽α1 1.6 mg皮下注射,每12小时1次,连续5 d,然后1.6 mg,皮下注射,每24小时1次,连续2 d,总疗程7 d。于治疗前及治疗后3、7 d,分别进行SOFA评分,检测CD4+、CD8+、CD4+/CD8+、单核细胞人类白细胞抗原DR位点(HLA-DR)。结果与治疗前相比,治疗组CD4+、CD4+/CD8+、HLADR明显升高,差异有统计学意义(P<0.05);CD8+下降,差异有统计学意义(P<0.05)。治疗组机械通气时间、ICU住院时间均较对照组缩短,SOFA评分较对照组明显下降,差异有统计学意义(P<0.05)。治疗组病死率较对照组下降,但差异未见统计学意义(P>0.05)。结论胸腺肽α1可以改善脓毒症患者细胞免疫功能,保护器官功能,缩短机械通气时间和ICU住院时间。Objective To discuss the effect of thymosin α1 on cellular immunity and prognosis in patients with severe sepsis. Methods Seventy-three patients who were over 18 years suffering from severe sepsis with APACHEⅡ score over 10,were randomly divided into two groups in the intensive care unit from May 2012 to December 2014. The patients in control group （35 cases）were treated by classical Surviving Sepsis Campaign（SSC）therapy,and patients in treatment group（38 cases）were treated with thymosin α1 and classical SSC therapy,in a dose of 1. 6 mg subcutaneous injection twice for 5 days,and 1. 6 mg subcutaneous injection for the other two days. The whole peroid of treatment was one week. The sequential organ failure assessment（SOFA）score were evaluated,meanwhile CD4 ＋ ,CD8 ＋ ,CD14 ＋ monocytes HLADR and CD4 ＋ / CD8 ＋ were measured before treatment,3 days and 7 days after the treatment. Results Compared with the variables before treatment,the levels of HLADR,CD4 ＋ ,CD4 ＋ / CD8 ＋ T lymphocytes were improved and CD8 ＋ T lymphocytes were reduced in thymosin α1 group（P 〈 0. 05）. The mechanical ventilation time,days of staying in ICU and SOFA score were fewer in thymosin α1 group than those in control group（P 〈 0. 05）. The 28-day mortality of the treatment group were reduced for patients in treatment group,but without statistically significant differences. Conclusion Thymosin α1 could improve cellular immunity,protect organ function,decrease the mechanical ventilation time and time of staying in ICU in patients of severe sepsis.

关 键 词：严重脓毒症 胸腺肽 细胞免疫 免疫调理 

分 类 号：R459.7[医药卫生—急诊医学]