中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2015年
1期
75-78
,共4页
乌司他丁%脓毒症%肾损伤%免疫功能
烏司他丁%膿毒癥%腎損傷%免疫功能
오사타정%농독증%신손상%면역공능
Ulinastatin%Sepsis%Renal injury%Immune function
目的：探讨乌司他丁对于脓毒症肾损伤的保护作用，并分析其对预后及免疫功能的影响，并探讨其可能的作用机制，为临床治疗提供依据。方法选择2010年3月~2014年2月浙江省丽水市人民医院收治的脓毒症患者46例，随机将所有患者分为对照组(22例)和观察组(24例)，对照组患者给予常规治疗和护理；观察组患者在常规治疗基础上应用乌司他丁治疗。主要评估患者治疗前后血尿素氮(BUN)、血肌酐(SCr)和胱抑素C(Cystatin C)含量、T细胞亚群结果，检测血清中肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平，并进行急性生理与慢性健康(APACHEⅡ)评分。结果两组患者治疗后Cystatin C、BUN和SCr均低于治疗前，差异均有统计学意义(P<0.05)；观察组患者治疗后Cystatin C、BUN和SCr分别为(1.21±0.24)mg/L、(14.92±1.23)mmol/L和(210.74±18.36)μmol/L，均低于对照组患者治疗后[(1.57±0.16)mg/L、(16.12±1.04)mmol/L和(254.33±23.82)μmol/L](P<0.05)；两组患者治疗后CD4+、CD8+和CD4+/CD8+与治疗前比较，差异均有统计学意义(P<0.05)。观察组患者治疗后CD4+和CD4+/CD8+分别为(43.87±5.04)%和(1.82±0.29)，均高于对照组治疗后[(38.04±4.51)%、(1.30±0.37)](P<0.05)。观察组患者治疗后CD8+为(31.92±3.26)%，低于对照组治疗后[(35.42±3.11)%]，差异有统计学意义(P<0.05)。两组患者治疗后TNF-α和IL-6与治疗前比较，差异均有统计学意义(P<0.05)。观察组患者治疗后TNF-α和IL-6分别为(201.66±17.44)、(173.54±15.8)ng/L，均低于对照组治疗后[(236.85±19.51)、(217.96±20.32)ng/L]，差异有统计学意义(P<0.05)。观察组患者治疗后APACHEⅡ评分为(15.60±1.23)分，低于对照组治疗后[(19.24±1.65)分]，且两组患者治疗后均低于治疗前(P<0.05)。结论乌司他丁对于脓毒症肾损伤患者具有保护作用，且能够显著改善患者的免疫功能，降低炎性因子，值得临床推广应用。
目的：探討烏司他丁對于膿毒癥腎損傷的保護作用，併分析其對預後及免疫功能的影響，併探討其可能的作用機製，為臨床治療提供依據。方法選擇2010年3月~2014年2月浙江省麗水市人民醫院收治的膿毒癥患者46例，隨機將所有患者分為對照組(22例)和觀察組(24例)，對照組患者給予常規治療和護理；觀察組患者在常規治療基礎上應用烏司他丁治療。主要評估患者治療前後血尿素氮(BUN)、血肌酐(SCr)和胱抑素C(Cystatin C)含量、T細胞亞群結果，檢測血清中腫瘤壞死因子-α(TNF-α)和白細胞介素-6(IL-6)水平，併進行急性生理與慢性健康(APACHEⅡ)評分。結果兩組患者治療後Cystatin C、BUN和SCr均低于治療前，差異均有統計學意義(P<0.05)；觀察組患者治療後Cystatin C、BUN和SCr分彆為(1.21±0.24)mg/L、(14.92±1.23)mmol/L和(210.74±18.36)μmol/L，均低于對照組患者治療後[(1.57±0.16)mg/L、(16.12±1.04)mmol/L和(254.33±23.82)μmol/L](P<0.05)；兩組患者治療後CD4+、CD8+和CD4+/CD8+與治療前比較，差異均有統計學意義(P<0.05)。觀察組患者治療後CD4+和CD4+/CD8+分彆為(43.87±5.04)%和(1.82±0.29)，均高于對照組治療後[(38.04±4.51)%、(1.30±0.37)](P<0.05)。觀察組患者治療後CD8+為(31.92±3.26)%，低于對照組治療後[(35.42±3.11)%]，差異有統計學意義(P<0.05)。兩組患者治療後TNF-α和IL-6與治療前比較，差異均有統計學意義(P<0.05)。觀察組患者治療後TNF-α和IL-6分彆為(201.66±17.44)、(173.54±15.8)ng/L，均低于對照組治療後[(236.85±19.51)、(217.96±20.32)ng/L]，差異有統計學意義(P<0.05)。觀察組患者治療後APACHEⅡ評分為(15.60±1.23)分，低于對照組治療後[(19.24±1.65)分]，且兩組患者治療後均低于治療前(P<0.05)。結論烏司他丁對于膿毒癥腎損傷患者具有保護作用，且能夠顯著改善患者的免疫功能，降低炎性因子，值得臨床推廣應用。
목적：탐토오사타정대우농독증신손상적보호작용，병분석기대예후급면역공능적영향，병탐토기가능적작용궤제，위림상치료제공의거。방법선택2010년3월~2014년2월절강성려수시인민의원수치적농독증환자46례，수궤장소유환자분위대조조(22례)화관찰조(24례)，대조조환자급여상규치료화호리；관찰조환자재상규치료기출상응용오사타정치료。주요평고환자치료전후혈뇨소담(BUN)、혈기항(SCr)화광억소C(Cystatin C)함량、T세포아군결과，검측혈청중종류배사인자-α(TNF-α)화백세포개소-6(IL-6)수평，병진행급성생리여만성건강(APACHEⅡ)평분。결과량조환자치료후Cystatin C、BUN화SCr균저우치료전，차이균유통계학의의(P<0.05)；관찰조환자치료후Cystatin C、BUN화SCr분별위(1.21±0.24)mg/L、(14.92±1.23)mmol/L화(210.74±18.36)μmol/L，균저우대조조환자치료후[(1.57±0.16)mg/L、(16.12±1.04)mmol/L화(254.33±23.82)μmol/L](P<0.05)；량조환자치료후CD4+、CD8+화CD4+/CD8+여치료전비교，차이균유통계학의의(P<0.05)。관찰조환자치료후CD4+화CD4+/CD8+분별위(43.87±5.04)%화(1.82±0.29)，균고우대조조치료후[(38.04±4.51)%、(1.30±0.37)](P<0.05)。관찰조환자치료후CD8+위(31.92±3.26)%，저우대조조치료후[(35.42±3.11)%]，차이유통계학의의(P<0.05)。량조환자치료후TNF-α화IL-6여치료전비교，차이균유통계학의의(P<0.05)。관찰조환자치료후TNF-α화IL-6분별위(201.66±17.44)、(173.54±15.8)ng/L，균저우대조조치료후[(236.85±19.51)、(217.96±20.32)ng/L]，차이유통계학의의(P<0.05)。관찰조환자치료후APACHEⅡ평분위(15.60±1.23)분，저우대조조치료후[(19.24±1.65)분]，차량조환자치료후균저우치료전(P<0.05)。결론오사타정대우농독증신손상환자구유보호작용，차능구현저개선환자적면역공능，강저염성인자，치득림상추엄응용。
Objective To explore the protective effects of Ulinastatin for the septic patients with renal injury, to analyze the influence on the prognosis and immune function, and to investigate its possible mechanism, and provide the basis for clinical therapy. Methods Forty six patients with sepsis were selected in the People's Hospital of Lishui City from March 2010 to February 2014. They were randomly divided into the control group (22 cases), who were treated with conventional treatment and nursing, and the observation group (24 cases) were treated with Ulinastatin on the basis of conventional therapy. The blood urea nitrogen (BUN) and serum creatinine (SCr) and Cystatin C (Cystatin C), T cell subsets were evaluated, the serum tumor necrosis factor-α (TNF-α) and interleukin -6 (IL-6) level, and acute physiology and chronic health evaluation (APACHE II) scores before and after treatment were detected. Results Cystatin, C, BUN and SCr of two groups after treatment were obviously lower than those before treatment, the differences were statistically significant (P<0.05). Cystatin C, BUN and SCr of the observation group after treatment were (1.21±0.24) mg/L, (14.92±1.23) mmol/L and (210.74±18.36) μmol/L, lower than the control group after treatment [(1.57±0.16) mg/L, (16.12±1.04) mmol/L and (254.33±23.82) μmol/L] (P< 0.05). Compared to before treatment, CD4+, CD8+ and CD4+/CD8+ of two groups, the differences were statistically significant (P<0.05). CD4+and CD4+/CD8+of the observation group after treatment was (43.87±5.04)% and (1.82±0.29), higher than that of the control group after treatment [(38.04±4.51)% and (1.30±0.37)] (P < 0.05). CD8+ of the observation group after treatment was (31.92±3.26)%, lower than the control group after treatment [(35.42±3.11)%] (P<0.05). TNF-αand IL-6 of two groups after treatment compared with before treatment, the difference was statistically significant (P < 0.05). TNF-αand IL-6 of the observation group after treatment were (201.66±17.44), (173.54±15.8) ng/L, lower than the control group after treatment [(236.85±19.51), (217.96±20.32) ng/L], there was a significant difference (P< 0.05). APACHEIIscore of the observation group after treatment was (15.60±1.23) scores, lower than the control group after treatment [(19.24±1.65) scores], and the two groups after treatment were lower than those before treatment (P<0.05). Conclusion There is better protective of Ulinastatin on septic renal injury, which can obviously improve the immune function, reduce the inflammatory factor, and it is worthy of clinical application.
