中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
22期
1743-1746
,共4页
冯文明%鲍鹰%费卯云%唐成武%王耀%柴振中%秦连进%黄三雄
馮文明%鮑鷹%費卯雲%唐成武%王耀%柴振中%秦連進%黃三雄
풍문명%포응%비묘운%당성무%왕요%시진중%진련진%황삼웅
脓毒症%生长抑素%腹腔%免疫调节
膿毒癥%生長抑素%腹腔%免疫調節
농독증%생장억소%복강%면역조절
Sepsis%Somatostatin%Abdominal cavity%Immunomodulation
目的 探讨生长抑素对严重腹腔脓毒症患者免疫炎性反应紊乱及预后的影响.方法 将2005年6月至2009年6月收治的53例年龄＞18岁、急性生理和慢性健康状况(APACHEⅡ)评分＞15分的严重腹腔脓毒症患者随机分为生长抑素组(n=23例)和经典治疗组(n=30例),选取同期年龄匹配的15名健康体检者作为对照组.经典治疗组给予经典拯救脓毒症运动治疗;生长抑素组在经典拯救脓毒症运动治疗的基础上联合运用14肽生长抑素(生长抑素)6 mg/24 h持续给药,连续7 d.观察比较患者入院时(d1)及治疗后第3天(d3)、第7天(d7)和第14天(d14)血清白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平和T细胞亚群CD4+、CD8+和CD4+/CD8+以及APACHEⅡ评分的动态变化和28 d病死率.结果 与对照组比较,严重腹腔脓毒症患者血清IL-10和TNF-α水平明显升高(P＜0.05),CD4+、CD8+和CD4+/CD8+明显降低(P＜0.05);与经典治疗组同期比较,生长抑素组d7、d14、CD4+、CD8+和CD4+/CD8+明显升高(P＜0.05),IL-10和TNF-α均明显下降(P＜0.05);生长抑素组d3、d7、d14的APACHE-Ⅱ评分较经典治疗组明显降低(P＜0.05);28 d内机械通气时间、ICU停留时间有所缩短,28 d病死率有所下降,但差异无统计学意义(P＞0.05).结论 严重腹腔脓毒症患者全身炎症反应和免疫抑制同时存在;生长抑素具有抗炎和免疫增强双向调节作用.
目的 探討生長抑素對嚴重腹腔膿毒癥患者免疫炎性反應紊亂及預後的影響.方法 將2005年6月至2009年6月收治的53例年齡＞18歲、急性生理和慢性健康狀況(APACHEⅡ)評分＞15分的嚴重腹腔膿毒癥患者隨機分為生長抑素組(n=23例)和經典治療組(n=30例),選取同期年齡匹配的15名健康體檢者作為對照組.經典治療組給予經典拯救膿毒癥運動治療;生長抑素組在經典拯救膿毒癥運動治療的基礎上聯閤運用14肽生長抑素(生長抑素)6 mg/24 h持續給藥,連續7 d.觀察比較患者入院時(d1)及治療後第3天(d3)、第7天(d7)和第14天(d14)血清白介素-10(IL-10)、腫瘤壞死因子-α(TNF-α)水平和T細胞亞群CD4+、CD8+和CD4+/CD8+以及APACHEⅡ評分的動態變化和28 d病死率.結果 與對照組比較,嚴重腹腔膿毒癥患者血清IL-10和TNF-α水平明顯升高(P＜0.05),CD4+、CD8+和CD4+/CD8+明顯降低(P＜0.05);與經典治療組同期比較,生長抑素組d7、d14、CD4+、CD8+和CD4+/CD8+明顯升高(P＜0.05),IL-10和TNF-α均明顯下降(P＜0.05);生長抑素組d3、d7、d14的APACHE-Ⅱ評分較經典治療組明顯降低(P＜0.05);28 d內機械通氣時間、ICU停留時間有所縮短,28 d病死率有所下降,但差異無統計學意義(P＞0.05).結論 嚴重腹腔膿毒癥患者全身炎癥反應和免疫抑製同時存在;生長抑素具有抗炎和免疫增彊雙嚮調節作用.
목적 탐토생장억소대엄중복강농독증환자면역염성반응문란급예후적영향.방법 장2005년6월지2009년6월수치적53례년령＞18세、급성생리화만성건강상황(APACHEⅡ)평분＞15분적엄중복강농독증환자수궤분위생장억소조(n=23례)화경전치료조(n=30례),선취동기년령필배적15명건강체검자작위대조조.경전치료조급여경전증구농독증운동치료;생장억소조재경전증구농독증운동치료적기출상연합운용14태생장억소(생장억소)6 mg/24 h지속급약,련속7 d.관찰비교환자입원시(d1)급치료후제3천(d3)、제7천(d7)화제14천(d14)혈청백개소-10(IL-10)、종류배사인자-α(TNF-α)수평화T세포아군CD4+、CD8+화CD4+/CD8+이급APACHEⅡ평분적동태변화화28 d병사솔.결과 여대조조비교,엄중복강농독증환자혈청IL-10화TNF-α수평명현승고(P＜0.05),CD4+、CD8+화CD4+/CD8+명현강저(P＜0.05);여경전치료조동기비교,생장억소조d7、d14、CD4+、CD8+화CD4+/CD8+명현승고(P＜0.05),IL-10화TNF-α균명현하강(P＜0.05);생장억소조d3、d7、d14적APACHE-Ⅱ평분교경전치료조명현강저(P＜0.05);28 d내궤계통기시간、ICU정류시간유소축단,28 d병사솔유소하강,단차이무통계학의의(P＞0.05).결론 엄중복강농독증환자전신염증반응화면역억제동시존재;생장억소구유항염화면역증강쌍향조절작용.
Objective To investigate the effect of somatostatin on inflammatory immune disorders and prognosis in patients with severe sepsis caused by abdominal diseases. Methods Fifty-three patients with severe abdominal sepsis (age ＞ 18 years, APACHE-Ⅱ score ＞ 15 ) from June 2005 to June 2009 were randomly divided into Somatostatin group ( n = 23 ) and SSC Group ( n = 30). Fifteen healthy volunteers of the same age range were chosen as Control group. The SSC group was treated with classical SSC therapy, and the Somatostatin Group was treated with the same regime plus 14-peptide somatostatin continuous infusion at the dose of 6 mg/24 h for 7 days. The serum levels of interleukin -10 (IL-10), tumor necrosis factor-α (TNF-α) were determined by using ELISA. CD4+, CD8+ T cell subsets were determined by fluorescence activated cell sorter(FACS) and CD4+/CD8+ was calculated. APACHE-Ⅱ score was observed on admission ( dl ) and day 3, 7 and 14 after treatment. Morality rates in 28 days in two groups were recorded. Results Compared with Control group, IL-10 and TNF-α levels were significantly elevated in patients with severe abdominal sepsis (P ＜0. 05), while CD4+, CD8+ T cell and CD4+/CD8+ decreased significanfly(P＜0. 05). Compared with the Somatostatin group CD4+, CD8+ T cell and CD4+/CD8+ on d7 and d14 in SSC Group were significantly increased ( P ＜ 0. 05 ), while IL-10 and TNF-α decreased significantly( P ＜0. 05 ). APACHE-Ⅱ scores on d3, d7, d14 of Somatostatin group were significantly lower than those of SSC group, and 28 d mortality rate also declined. Conclusions In patients with severe abdominal sepsis, systemic inflammatory response and immune suppression exist simultaneously.Somatostatin has a dual immunomodulatory activity in these patients.
