甲泼尼龙与氢化可的松治疗脓毒症休克患者的疗效及其对血流动力学和miR-155表达的影响  

The inflammatory efficacy of methylprednisolone and hydrocortisone in the treatment of patients with septic shock and their effects on hemodynamics and miR-155

作　　者：陈侯君[1] 冯劲立[1] 谢昌联[2] CHEN Hou-jun;FENG Jin-li;XIE Chang-lian(Department of Emergency,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,Guangdong,China;Department of Intensive Care Unit,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,Guangdong,China)

机构地区：[1]中山市中医院,急诊科,广东中山528400 [2]中山市中医院,重症监护科,广东中山528400

出　　处：《川北医学院学报》2024年第12期1608-1611,1619,共5页Journal of North Sichuan Medical College

基　　金：广东省自然科学基金项目(2020A1515010108)。

摘　　要：目的:探讨甲泼尼龙与氢化可的松治疗脓毒症休克患者的疗效及其对血流动力学和miR-155表达的影响。方法:选取104例脓毒症休克患者为研究对象,按照治疗方案不同分为氢化可的松组和甲泼尼龙组,每组各52例。在给予去甲肾上腺素治疗的基础上,氢化可的松组患者给予氢化可的松(200 mg/d)治疗;甲泼尼龙组患者给予甲泼尼龙(40 mg/d)治疗,疗程均为7 d。比较两组患者临床疗效、炎症因子[降钙素原(PCT)、白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子α(TNF-α)]水平、miR-155表达水平、血流动力学[中心静脉压(CVP)、平均动脉压(MAP)及心率(HR)]、免疫功能(CD3^(+)T、CD4^(+)T及CD8^(+)水平)及不良反应发生情况。结果:甲泼尼龙组患者临床疗效优于氢化可的松组(P<0.05)。治疗后,两组患者PCT、IL-6、hs-CRP、TNF-α水平及HR均降低(P<0.05),且甲泼尼龙组低于氢化可的松组(P<0.05);CVP、MAP均升高,且甲泼尼龙组高于氢化可的松组(P<0.05);CD3^(+)T、CD4^(+)T及CD8^(+)T水平均升高(P<0.05),且甲泼尼龙组CD3^(+)T及CD4^(+)T高于氢化可的松组(P<0.05)。治疗1、3、7 d后,甲泼尼龙组miR-155表达水平均低于氢化可的松组(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:甲泼尼龙与氢化可的松均能安全有效治疗脓毒症休克,但甲泼尼龙在降低炎症、改善血流动力学及增加T淋巴细胞数量方面更具优势,值得临床推广应用。Objective:To investigate the inflammatory efficacy of methylprednisolone and hydrocortisone in the treatment of patients with septic shock and their effects on hemodynamics and miR-155.Methods:104 patients with septic shock were divided into hydrocortisone group(n=52)and methylprednisolone group(n=52)according to different treatment regimens.The hydrocortisone group received hydrocortisone 200 mg/d combined with norepinephrine,while the methylprednisolone group received methylprednisolone 40 mg/d combined with norepinephrine for 7 consecutive days.Clinical efficacy,inflammatory factors[procalcitonin(PCT),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),and tumor necrosis factorα(TNF-α)],miR-155,hemodynamics[central venous pressure(CVP),mean arterial pressure(MAP),and heart rate(HR)],immune function(CD3^(+)T,CD4^(+)T,and CD8^(+)levels),and adverse reactions were compared between the two groups.Results:The therapeutic efficacy of the methylprednisolone group was higher than that of the hydrocortisone group(P<0.05).After treatment,the levels of PCT,IL-6,hs-CRP,TNF-α,and HR in the two groups were decreased,and the indexes in the methylprednisolone group were lower than those in the hydrocortisone group(P<0.05).The CVP and MAP in the two groups were increased.The CVP and MAP in the methylprednisolone group were higher than those in the hydrocortisone group(P<0.05).The levels of CD3^(+)T,CD4^(+)T and CD8^(+)T in the two groups increased,and the levels of CD3^(+)T and CD4^(+)T in the methylprednisolone group were higher than those in the hydrocortisone group(P<0.05).After 1,3 and 7 d of treatment,the level of miR-155 in the methylprednisolone group was lower than that in the hydrocortisone group(P<0.05).No significant difference was found in the incidence of adverse effects between the two groups(P>0.05).Conclusion:Both methylprednisolone and hydrocortisone can effectively and safely treat septic shock,but methylprednisolone has more advantages in reducing inflammation,improving hemodynamics and increa

关 键 词：甲泼尼龙 氢化可的松 脓毒症休克 MIR-155 血流动力学 

分 类 号：R631[医药卫生—外科学]