论文部分内容阅读
目的：观察脾多肽注射液对 ICU 严重脓毒症患者免疫调节作用的影响。方法选择40例严重脓毒症患者，经患者知情同意后随机分成两组，治疗组20例患者在使用抗生素时联合应用脾多肽注射液治疗，对照组20例患者不接受脾多肽注射液治疗，其余常规治疗两组基本相同。患者入院后进行血培养＋药敏试验，评估两组患者治疗前与治疗后第3、7和第10天时的序贯器官衰竭（SOFA）评分，留取各时间点外周血送检验科，监测白细胞（WBC）、中性粒细胞比率（NEU％）、降钙素原（PCT）、超敏 C 反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、T 淋巴细胞总数（CD ＋3）及亚群数（CD ＋4、CD ＋8、CD ＋4／CD ＋8）的动态变化，同时观察有无药物不良事件发生。结果脾多肽治疗7 d 后，治疗组 SOFA 评分为（3．48±1．83）分，较治疗前的（5.56±2．03）分明显下降，且治疗组 SOFA 评分下降的程度与对照组相比，差异有统计学意义（t ＝2．793，P ＜0.05）；脾多肽治疗10 d 后治疗组 SOFA 评分下降程度明显优于对照组（t ＝4．4019，P ＜0．01）；在炎症指标的改善程度方面，两组较治疗前均有改善，但脾多肽治疗组改善程度明显优于对照组，IL-6在脾多肽治疗第7天时为（37．61±7.51）mg／L，对照组为（50．49±7．68）mg／L，两组差异有统计学意义（t ＝1．969，P ＜0．01）；对照组的中性粒细胞比率无明显改善；在改善机体免疫指标方面，脾多肽治疗组的 CD ＋3、CD ＋4和 CD ＋4／CD ＋8治疗3 d 后较治疗前明显升高[治疗前：（41．27±6．91）％、（19．65±5．29）％和（0．96±0．42）；治疗后：（46．57±7．11）％、（24．99±7．70）％和（1．27±0．39）]，CD ＋8明显降低[治疗前：（25．62±5．18）％，治疗后（23．51±3．19）％]，在改善时间和程度上均优于对照组（t ＝1．390，t ＝1．407，t ＝3．974和 t ＝2．081，均 P ＜0．05），治疗组改善机体免疫状态的疗效优于对照组；未观察到脾多肽注射液的严重药物不良事件。结论脾多肽注射液作为免疫调节剂，可有效改善 ICU 内严重脓毒症患者的免疫功能。“,”Objective To investigate the effect of lineal polypeptide injection on immune function of severe sepsis patients in ICU.Methods 40 severe sepsis patients in ICU were randomly divided into two groups after signed the consent form:the treatment group (20 cases)and the control group (20 cases).On the 1st day of antibiotic therapy, the patients in the treatment group were simultaneously treated with lineal polypeptide intravenous injection,while the patients in the control group received the same routine treatment,but without lineal polypeptide injection,all with a 10 days treatment course.Blood bacteria culture and drug sensitivity test were completed after entering the hospital. The scores of Sequential Organ Failure Assessment(SOFA)before treatment and at day 3,7 and 10 of therapy were evaluated.The peripheral blood of patients was taken and send to the clinical laboratory.The WBC,NEU%,PCT, hs -CRP,IL -6,total T lymphocytes (CD +3 )and T lymphocyte subgroup (CD +4 ,CD +8 ,CD +4 /CD +8 )were detected in both the treatment group and the control group.Adverse drug events were also detected in the process of therapy. Results Compared with before treatment[(5.56 ±2.03)points],after 7 days of lineal polypeptide therapy,the SOFA score of the treatment group[(3.48 ±1.83)points]decreased significantly(t =2.793,P <0.05),and after10 days therapy,the descending degree in the treatment group was more significantly and declined earlier than the control group (t =4.401,P <0.01 ).In the aspect of improving the inflammatory markers,two groups were all improved after therapy,but the degree of improvement in the treatment group was better than the control group.After 7 days therapy,IL -6 level was (37.61 ±7.51)mg/L in the treatment group,while (50.49 ±7.68)mg/L in the control group (t =1.969,P <0.01),and the improvement of NEU% was not found in control group.In the aspect of improving the immune function,the CD +3 ,CD +4 ,CD +4 /CD +8 ratios were increased significantly [before therapy:(41.27 ±6.91)%,(19.65 ±5.29)% and (0.96 ±0.42);after 3 days therapy:(46.57 ±7.11 )%,(24.99 ± 7.70)%,(1.27 ±0.39)],and CD +8 [before therapy:(25.62 ±5.18)%,after 3 days therapy:(23.51 ±3.19)%] was decreased dramatically after 3 days of lineal polypeptide injection treatment,there was significant improvement in time and degree in the treatment group compared with the control group (t =1.390,t =1.407,t =3.974,t =2.081, all P <0.05).No severe adverse drug events were found.Conclusion As an immune modulator,lineal polypeptide injection could effectively improve the immune function of severe sepsis patients in ICU.