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目的探讨严重脓毒症患者接受免疫调理治疗后的病情转归和胸腺肽α1对机体细胞免疫的影响。方法选择2012年5月至2014年12月入住重症监护室年龄>18岁、APACHEⅡ评分>10分的严重脓毒症患者73例,随机分为对照组和治疗组。对照组(35例)采取经典ICU治疗,以《拯救脓毒症运动之严重脓毒症及休克治疗指南》为标准;治疗组(38例)除经典治疗外,给予胸腺肽α1 1.6 mg皮下注射,每12小时1次,连续5 d,然后1.6 mg,皮下注射,每24小时1次,连续2 d,总疗程7 d。于治疗前及治疗后3、7 d,分别进行SOFA评分,检测CD4+、CD8+、CD4+/CD8+、单核细胞人类白细胞抗原DR位点(HLA-DR)。结果与治疗前相比,治疗组CD4+、CD4+/CD8+、HLADR明显升高,差异有统计学意义(P<0.05);CD8+下降,差异有统计学意义(P<0.05)。治疗组机械通气时间、ICU住院时间均较对照组缩短,SOFA评分较对照组明显下降,差异有统计学意义(P<0.05)。治疗组病死率较对照组下降,但差异未见统计学意义(P>0.05)。结论胸腺肽α1可以改善脓毒症患者细胞免疫功能,保护器官功能,缩短机械通气时间和ICU住院时间。
Objective To investigate the prognosis of patients with severe sepsis after immunomodulatory treatment and the effect of thymosin α1 on cellular immunity. Methods From May 2012 to December 2014, 73 patients with severe sepsis admitted to ICU> 18 years old and APACHEⅡ score> 10 were randomly divided into control group and treatment group. The control group (35 cases) took the classic ICU treatment as the guideline of “Severe Sepsis and Shock Treatment to Rescued Sepsis”; the treatment group (38 cases) was given subcutaneous injection of thymosin α1 1.6 mg, Every 12 hours for 5 consecutive days and then 1.6 mg subcutaneously once every 24 hours for 2 consecutive days for a total duration of 7 days. SOFA score and CD4 +, CD8 +, CD4 + / CD8 + and monocyte HLA-DR were measured before treatment and 3 and 7 days after treatment. Results Compared with those before treatment, the levels of CD4 +, CD4 + / CD8 + and HLADR in the treatment group were significantly increased (P <0.05), while the levels of CD8 + in the treatment group were significantly decreased (P <0.05). The duration of mechanical ventilation and ICU stay in the treatment group was shorter than that in the control group, and the SOFA score was significantly lower than that in the control group (P <0.05). The treatment group mortality decreased compared with the control group, but the difference was not statistically significant (P> 0.05). Conclusion Thymosin α1 can improve cellular immune function, protect organ function, shorten the duration of mechanical ventilation and ICU stay in sepsis patients.