乌司他丁对急性呼吸窘迫综合征患者炎症反应及细胞免疫功能的影响  

Influence of ulinastatin on inflammatory response and cellular immune function in patients with acute respiratory distress syndrome

作　　者：徐彦立 王明强[2] 胡振杰[1] 

机构地区：[1]郑州市第六人民医院急诊科,450015 [2]郑州大学第二附属医院ICU,450003

出　　处：《实用医学杂志》2017年第7期1141-1145,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:81173402)

摘　　要：目的:观察乌司他丁(UTI)对急性呼吸窘迫综合征(ARDS)患者疗效、炎症因子及细胞免疫状态的影响。方法:将96例ARDS患者随机分为两组:对照组(48例)给予常规治疗;UTI组(48例)在对照组治疗的基础上应用UTI。比较两组患者治疗前后氧合指数、生命体征、炎症因子及T淋巴细胞亚群的变化,并记录两组患者的机械通气时间、ICU治疗时间及ICU内死亡率。结果:治疗7 d后,UTI组患者的生命体征(RF、HR、MAP)、炎症因子(TNF-a、IL-6、IL-8、PCT、CRP、WBC)、肝功能(AST、ALT)、肾功能(BUN、Cr)及APACHEⅡ评分、MODS评分均低于对照组(P<0.05或P<0.01),氧合指数(PaO_2/FiO_2)及细胞免疫(CD4^+、CD4^+/CD8^+)均高于对照组(P<0.01)。UTI组患者的机械通气时间、ICU治疗时间短于对照组(均P<0.05),UTI组患者的ICU内死亡率低于对照组(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论:UTI用于ARDS能更有效地改善氧代谢和生命体征,改善肝肾功能,降低APACHEⅡ评分、MODS评分,缩短机械通气时间、ICU治疗时间,降低ICU内死亡率,其机制可能与UTI清除体内炎症因子和调节细胞免疫功能有关。Objective To observe the influence of ulinastatin （UTI） on curative effect,inflammatory response and cellular immune function in patients with acute respiratory distress syndrome （ARDS）. Methods 96 patients with ARDS were randomly divided into two groups： the control group （48 cases） were treated with conventional treatment, and the UTI group （48 eases） were added with UTI injection based on the control group treatment. The changes of oxygenation index, vital signs, inflammatory factors and T lymphocyte subsets of patients in the two groups were compared before treatment and after treatment in 7 days,recorded the duration of mechanical ventilation time, ICU treatment time and mortality rate in ICU in the two groups. Results After treatment in 7 days, the vital signs （RF, HR, MAP）, inflammatory factors （TNF-c~, IL-6, IL-8, PCT, CRP, WBC）, liver function （AST, ALT）, renal function （BUN, Cr） and APACHE lI score, MODS score of UTI patients in the UTI group were lower than those in the control group （P 〈 0.05 or P 〈 0.01）. Oxygenation index （PaO2/FiO2） and cellular immunity （CD4＋,CD4＋/CD,~） in the UTI group were higher than those in the control group （P 〈 0.01）. Mechanical ventilation time, ICU treatment time in the UTI group were shorter than those in the control group （all P 〈 0.05）, the mortality rate of ICU in the UTI group was lower than that in the control group （P 〈0.05）.There was no significant difference in the incidence of adverse reactions between the two groups （P 〉 0.05）. Conclusions UTI can more effectively improve oxygen metabolism, vital signs for ARDS, liver and kidney function, reduce the APACHE II score and MODS score, shorten the mechanical ventilation time and ICU treatment time, reduce the mortality rate of ICU. Its mechanism may relate to clearance of inflammatory factors and regulate cellular immune function of UTI.

关 键 词：乌司他丁 急性呼吸窘迫综合征 炎症因子 氧合指数 T淋巴细胞亚群 

分 类 号：R563.8[医药卫生—呼吸系统]