脱氧核苷酸钠片治疗成人病毒性心肌炎的免疫学观察  

Observation on the immunological changes of patients with adult viral myocarditis treated with sodium deoxynucleotide tablet

作　　者：池东 潘胜平 周文 CHI Dong;PAN Shengping;ZHOU Wen(Department of Emergency,Wenzhou Chinese and Western Medicine Association Hospital,Wenzhou,Zhejiang 325000,China)

机构地区：[1]浙江省温州市中西医结合医院急诊科,325000

出　　处：《重庆医学》2020年第14期2368-2372,共5页Chongqing medicine

基　　金：温州市科技计划项目(R20160835)。

摘　　要：目的观察脱氧核苷酸钠片对成人病毒性心肌炎(VMC)的免疫调节作用。方法选取该院2015年1月至2018年1月收治的78例新发成人VMC患者,分为观察组(常规治疗^+脱氧核苷酸钠片治疗)和对照组(常规治疗),各39例。另选取同时期做健康体检的健康成人20例作为健康对照组。两组患者均治疗3个疗程,分别在入组时、治疗第1、2、3个疗程后进行急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,检测患者外周血T淋巴细胞亚群[自然杀伤细胞(NK细胞),CD3^+、CD4^+、CD8^+细胞百分比,CD4^+/CD8^+比值]和细胞因子[白细胞介素(IL)-2、IL-6、肿瘤坏死因子α(TNF-α)]水平的变化,并与健康对照组进行比较。结果经过3个疗程治疗后,两组患者APACHEⅡ评分降低,且观察组APACHEⅡ评分低于对照组,差异均有统计学意义(P<0.05);两组患者免疫功能和细胞因子水平都有一定的恢复,且观察组患者NK细胞、CD3^+、CD4^+细胞百分比及CD4^+/CD8^+比值高于对照组患者,细胞因子水平低于对照组,差异有统计学意义(P<0.05)。患者外周血淋巴细胞亚群CD4^+/CD8^+比值、IL-6水平与不同临床疾病类型有关(P<0.05),患者IL-2、IL-6、TNF-α水平与不同病毒感染类型相关(P<0.05)。结论脱氧核苷酸钠片+常规治疗能更有效地治疗成人VMC,可能与其改善免疫调节功能及恢复细胞因子稳态有关。Objective To observe the immunomodulatory effect of sodium deoxynucleotide tablet on adult viral myocarditis(VMC).Methods A total of 78 new-onset adult VMC patients admitted to this hospital from January 2015 to January 2018 were selected and divided into the observation group(received conventional treatment^+sodium deoxynucleotide tablet)and the control group(received conventional treatment),39 cases in each group.In addition,20 healthy adults who took physical examinations during the same period were selected as the healthy control group.Both groups of patients were treated for 3 courses.At the time of enrollment and after the first,second,and third courses of treatment,the acute physiology and chronic health evaluationⅡ(APACHEⅡ)scoring system was used to evaluate clinical status;the peripheral blood T lymphocyte subsets,including natural killer cells(NK cells),percentage of CD3^+,CD4^+,CD8^+cells and the ratio of CD4^+/CD8^+cells,and levels of cytokines,including interleukin(IL)-2,IL-6,tumor necrosis factorα(TNF-α),were detected and compared wiht those in the healthy control group.Results After three courses of treatment,the APACHEⅡscores of patients in the two groups decreased,and the APACHEⅡscore of the observation group was lower than that of the control group,the difference was statistically significant(P<0.05);the immune function and cytokine levels of patients in the two groups had certain recovery,the percentage of NK cells,CD3^+,CD4^+cells and ratio of CD4^+/CD8^+in the observation group were higher than those in the control group,and the cytokine levels were lower than those in the control group,the differences were statistically significant(P<0.05).The peripheral blood lymphocyte subsets,including ratio of CD4^+/CD8^+and IL-6 levels,were related to different types of clinical diseases(P<0.05).The levels of IL-2,IL-6 and TNF-αwererelated to different types of virus infection(P<0.05).Conclusion The sodium deoxynucleotide tablet combined with conventional therapy can more effectively treat ad

关 键 词：心肌炎 感染 脱氧核苷酸钠 免疫调节 T淋巴细胞 细胞因子类 

分 类 号：R542.21[医药卫生—心血管疾病]