中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
3期
147-150
,共4页
苏磊%孟繁甦%唐柚青%文强%刘云松%唐丽群%段鹏凯%罗锐军
囌磊%孟繁甦%唐柚青%文彊%劉雲鬆%唐麗群%段鵬凱%囉銳軍
소뢰%맹번소%당유청%문강%류운송%당려군%단붕개%라예군
脓毒症%乌司他丁%胸腺肽α1%免疫调理%辅助性T细胞%CD14+单核细胞%人白细胞DR抗原
膿毒癥%烏司他丁%胸腺肽α1%免疫調理%輔助性T細胞%CD14+單覈細胞%人白細胞DR抗原
농독증%오사타정%흉선태α1%면역조리%보조성T세포%CD14+단핵세포%인백세포DR항원
sepsis%ulinastatin%thymosin α1%immuno-modulation%helper T lymphocyte%CD14+ monocyte%human leucocyte antigen DR
目的 分析乌司他丁联合胸腺肽α1对脓毒症患者免疫调理的临床疗效.方法 采用随机对照研究方法 收集2004年10月-2008年6月本院重症监护病房(ICU)符合入选标准的脓毒症患者242例.对照组114例,采用2004年脓毒症诊治指南规范的经典治疗方案,包括早期目标复苏、抗生素治疗、呼吸机支持及血液净化等.治疗组128例,在经典治疗基础上加用乌司他丁200 kU静脉滴注,每日2次、连用4 d后改为100 kU静脉泵入,每日2次、连用6 d;同时胸腺肽α1(迈普新)1.6 mg皮下注射,每日2次、连用4 d后改为每日1次、连用6 d.疗程均为10 d.观察两组患者一般情况,记录急性生理学与慢性健康状况评分系统I(APACHE I)评分.取外周血,用酶联免疫吸附法(ELIsA)检测血清白细胞介素-6(IL-6)、IL-10含量,流式细胞仪检测CD14+单核细胞人白细胞DR抗原(HLA-DR)表达率及辅助性T细胞Th1型细胞因子γ-干扰素(CD4+IFN-γ+)与Th2型细胞因子(CD4+IL-4+)比值.终末观察指标为感染病程、机械通气时间、ICU住院天数、多器官功能障碍综合征(MODS)发生率及28 d病死率.结果 两组患者治疗前各指标比较差异均无统计学意义(P均>0.05).治疗组治疗后外周血CD14+单核细胞HLA-DR表达率、CD4+IFN-γ+/CD4+IL-4+比值均明显升高(P均<0.05);血清IL-6、IL-10含量及APACHEⅡ评分均明显下降,且与对照组比较差异亦有统计学意义(P均<0.05).治疗组MODS发生率明显低于对照组(21%比47%,P<0.05),机械通气时间明显缩短[(6.08±2.46)d比(8.23±3.47)d,P<0.05];而两组间感染病程及ICU住院天数比较差异均无统计学意义(P均>0.05).治疗组28 d病死率明显低于对照组(20%比33%,P<0.05).结论 给予脓毒症患者乌司他丁和胸腺肽α1联用的免疫调理方案后能明显改善患者的机械通气时间、MODS发生率及28 d病死率,这与改善脓毒症患者的免疫失衡状态有关;但对病程及ICU住院天数无明显影响.
目的 分析烏司他丁聯閤胸腺肽α1對膿毒癥患者免疫調理的臨床療效.方法 採用隨機對照研究方法 收集2004年10月-2008年6月本院重癥鑑護病房(ICU)符閤入選標準的膿毒癥患者242例.對照組114例,採用2004年膿毒癥診治指南規範的經典治療方案,包括早期目標複囌、抗生素治療、呼吸機支持及血液淨化等.治療組128例,在經典治療基礎上加用烏司他丁200 kU靜脈滴註,每日2次、連用4 d後改為100 kU靜脈泵入,每日2次、連用6 d;同時胸腺肽α1(邁普新)1.6 mg皮下註射,每日2次、連用4 d後改為每日1次、連用6 d.療程均為10 d.觀察兩組患者一般情況,記錄急性生理學與慢性健康狀況評分繫統I(APACHE I)評分.取外週血,用酶聯免疫吸附法(ELIsA)檢測血清白細胞介素-6(IL-6)、IL-10含量,流式細胞儀檢測CD14+單覈細胞人白細胞DR抗原(HLA-DR)錶達率及輔助性T細胞Th1型細胞因子γ-榦擾素(CD4+IFN-γ+)與Th2型細胞因子(CD4+IL-4+)比值.終末觀察指標為感染病程、機械通氣時間、ICU住院天數、多器官功能障礙綜閤徵(MODS)髮生率及28 d病死率.結果 兩組患者治療前各指標比較差異均無統計學意義(P均>0.05).治療組治療後外週血CD14+單覈細胞HLA-DR錶達率、CD4+IFN-γ+/CD4+IL-4+比值均明顯升高(P均<0.05);血清IL-6、IL-10含量及APACHEⅡ評分均明顯下降,且與對照組比較差異亦有統計學意義(P均<0.05).治療組MODS髮生率明顯低于對照組(21%比47%,P<0.05),機械通氣時間明顯縮短[(6.08±2.46)d比(8.23±3.47)d,P<0.05];而兩組間感染病程及ICU住院天數比較差異均無統計學意義(P均>0.05).治療組28 d病死率明顯低于對照組(20%比33%,P<0.05).結論 給予膿毒癥患者烏司他丁和胸腺肽α1聯用的免疫調理方案後能明顯改善患者的機械通氣時間、MODS髮生率及28 d病死率,這與改善膿毒癥患者的免疫失衡狀態有關;但對病程及ICU住院天數無明顯影響.
목적 분석오사타정연합흉선태α1대농독증환자면역조리적림상료효.방법 채용수궤대조연구방법 수집2004년10월-2008년6월본원중증감호병방(ICU)부합입선표준적농독증환자242례.대조조114례,채용2004년농독증진치지남규범적경전치료방안,포괄조기목표복소、항생소치료、호흡궤지지급혈액정화등.치료조128례,재경전치료기출상가용오사타정200 kU정맥적주,매일2차、련용4 d후개위100 kU정맥빙입,매일2차、련용6 d;동시흉선태α1(매보신)1.6 mg피하주사,매일2차、련용4 d후개위매일1차、련용6 d.료정균위10 d.관찰량조환자일반정황,기록급성생이학여만성건강상황평분계통I(APACHE I)평분.취외주혈,용매련면역흡부법(ELIsA)검측혈청백세포개소-6(IL-6)、IL-10함량,류식세포의검측CD14+단핵세포인백세포DR항원(HLA-DR)표체솔급보조성T세포Th1형세포인자γ-간우소(CD4+IFN-γ+)여Th2형세포인자(CD4+IL-4+)비치.종말관찰지표위감염병정、궤계통기시간、ICU주원천수、다기관공능장애종합정(MODS)발생솔급28 d병사솔.결과 량조환자치료전각지표비교차이균무통계학의의(P균>0.05).치료조치료후외주혈CD14+단핵세포HLA-DR표체솔、CD4+IFN-γ+/CD4+IL-4+비치균명현승고(P균<0.05);혈청IL-6、IL-10함량급APACHEⅡ평분균명현하강,차여대조조비교차이역유통계학의의(P균<0.05).치료조MODS발생솔명현저우대조조(21%비47%,P<0.05),궤계통기시간명현축단[(6.08±2.46)d비(8.23±3.47)d,P<0.05];이량조간감염병정급ICU주원천수비교차이균무통계학의의(P균>0.05).치료조28 d병사솔명현저우대조조(20%비33%,P<0.05).결론 급여농독증환자오사타정화흉선태α1련용적면역조리방안후능명현개선환자적궤계통기시간、MODS발생솔급28 d병사솔,저여개선농독증환자적면역실형상태유관;단대병정급ICU주원천수무명현영향.
Objective To analyze clinical effect of immuno-modulatory therapy with ulinastatin and thymosin α1 on patients with sepsis. Methods Two hundred and forty-two septic patients admitted to Guangzhou General Hospital of Guangzhou Military Command intensive care unit (ICU) during 2004.10-2008.6 were included, and they were randomly divided into treatment group (128 cases) and control group (114 cases). The patients in control group were given regular conventional treatment according to Surviving Sepsis Campaign (SSC) in 2004, including early fluid resuscitation, antibiotic therapy, mechanical ventilation (MV) and blood purification. The treatment group received conventional treatment plus immuno-modulation therapy including ulinastatin (first 200 kU injection intravenous twice a day for 4 days and 100 kU for another 6 days) and thymosin α1 (1.6 mg subcutaneous twice a day for 4 days, followed by 1.6 mg per day subcutaneous for another 6 days). The total treatment course was 10 days. General demographics were observed, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores were recorded. Serum interleukin-6 (IL-6), IL-10 levels of peripheral blood were detected by enzyme linked immunosorbent assay (ELISA). Peripheral blood CD14+ monocyte human leucocyte antigen DR (HLA-DR) expression, and ratio of helper T lymphocyte 1 (Th1) cytokines interferon-γ (CD4+IFN-γ+), and Th2 cytokines (CD4+ IL-4+) were assessed with flow cytometer. Duration of infection and MV, length of ICU stay, rate of development of multiple organ dysfunction syndrome (MODS) and mortality rate on 28 days were observed as end-point. Results Before treatment, there was no difference in all biomarkers between two groups (all P>0.05). After treatment, peripheral blood CD14+ monocyte HLA-DR expression and the ratio of CD4+IFN-γ+/CD4+ IL-4+ increased significantly in the treatment group (both P<0.05), with serum IL-6, IL-10 levels and APACHEⅡ scores all reduced remarkably (all P<0.05). The values showed significant differences compared with those of control group (all P<0.05). The MODS development rate in the treatment group was much lower than that of control group (21% vs. 47%, P<0.05), and the length of use of MV was significantly reduced [(6.08±2.46) days vs. (8.23±3.47) days, P<0.05]. There was no difference in the infection duration and length of ICU stay (both P>0.05). The mortality rate on 28 days in the treatment group was much lower than that in control group (20% vs. 33%, P<0.05). Conclusion The immuno-modulation therapy of ulinastatin and thymosin α1 can remarkably improve the duration of MV and the development rate of MODS and mortality rate on 28 days in the patients with sepsis, probably due to its effect in ameliorating the immuno-imbalance state of the patients. However, the duration of infection and length of ICU stay are not effected.
