小剂量糖皮质激素对严重脓毒症患者血CRP、CD64指数和HLA-DR水平的影响  

Effect of low dose glucocorticoid on blood CRP,CD64 index and HLA-DR level in patients with severe sepsis

作　　者：喻秋平[1] 杨蕙文[1] 叶兴文[1] 李力[1] 罗洋[1] 刘松[1] 赵鑫[1] 

机构地区：[1]九江学院附属医院,九江332000

出　　处：《内科急危重症杂志》2017年第4期312-314,共3页Journal of Critical Care In Internal Medicine

基　　金：江西省卫生厅科技项目课题(No:20177137)

摘　　要：目的:探讨小剂量糖皮质激素对严重脓毒症患者早期炎症反应指标和免疫功能指标的影响。方法:将95例确诊为严重脓毒症患者随机分为激素组(49例)和非激素组(46例)。激素组在综合治疗基础上给予氢化可的松100 mg,2次/d,持续静脉滴入,连续给药7 d。观察2组患者入院时的生命体征,检测入院时及入院第1、3、5、7天血C-反应蛋白(CRP)、中性粒细胞CD64及单核细胞HLA-DR水平。结果:2组患者治疗后血CRP水平均较治疗前降低,治疗后激素组各时点血CRP水平均低于非激素组(均P<0.01)。自治疗第3天始,激素组各时点外周血中性粒细胞CD64水平均低于非激素组(P<0.01)。治疗第3天,2组患者血单核细胞HLADR水平比较(P<0.05);第5、7天2组患者差异具有显著统计学意义(P<0.01)。结论:严重脓毒症患者早期使用小剂量糖皮质激素,可以显著抑制全身炎症反应,并有助于改善患者免疫功能。Objective： To explore the effects of low dose glucocorticoid on early inflammatory response indicators and immune function indicators in patients with severe sepsis. Methods： Ninety-five patients with severe sepsis were randomly divided into two groups： hormone group（ n = 49） and non-hormone group（ n = 46）. Hormone group on the basis of comprehensive treatment was given intravenous infusion of hydrocortisone（ 100 mg,two times every day） for consecutive 7 days. The vital signs at admission,and blood CRP,neutrophil CD64 and monocyte HLA-DR levels at admission and 3rd,5th and 7th day after admission were observed. Results： After treatment,the CRP levels were reduced as compared with those before treatment in the two groups. The levels of CRP were lower in the hormone group than in the non-hormone group at different time points after treatment（ P〈0. 01）. From the 3rd day after treatment,the levels of CD64 in peripheral blood neutrophils were lower in the observation group than those in the non-hormonal group（ P〈0. 01）,and the HLA-DR level of monocytes showed significant difference between the two groups（ P〈0. 05 or 0. 01）. Conclusions： Early use of small doses of glucocorticoid in patients with severe sepsis can significantly inhibit systemic inflammatory response and improve the immune function of patients.

关 键 词：糖皮质激素 严重脓毒症 CRP CD64 HLA-DR 

分 类 号：R515.3[医药卫生—内科学]