摘要
目的研究创伤、严重脓毒症和多器官功能障碍综合征（MODS）免疫调理治疗作用。方法前瞻性分析70例符合创伤、严重脓毒症和MODS标准病人，随机分成对照组和治疗组，对照组常规治疗，治疗组常规治疗联合使用蛋白酶抑制剂和胸腺肽仅1治疗（常规治疗＋免疫调理），免疫调理疗程为7d，分别观察治疗前和治疗后1、3、7、14和28d相关免疫学指标：淋巴细胞计数、CD4、CD8、CD4／CD8，CD14^＋单核细胞HLA—DR水平的动态变化。结果对照组死亡20例，治疗组死亡13例，P〈0．05为差异有显著性意义。治疗组CD4在7～14d较对照组明显升高，P〈0．05；治疗组CD8则在14d较对照组明显升高，P〈0．05；在治疗7d内，两组CD4／CD8差异没有显著性，P〉0．05；但是在停免疫调理治疗后，治疗组cD4／CD8会出现有意义的下降，P〈0．05。治疗组的淋巴细胞计数及CD14^＋单核细胞HLA—DR水平在7d较对照组显著性升高，持续至治疗后28d，P〈0．05。结论免疫调理治疗可以改善创伤、严重脓毒症和MODS病人住院28d内的预后，可以升高淋巴细胞和CD0单核细胞HLA-DR水平，值得推荐临床使用。免疫调理治疗对CD。和CD。的升高作用则有不同步或延迟现象，可能与危重病人T细胞亚群对免疫调理的应答时间不一致和（或）T细胞亚群具有双向调节作用有关。治疗7d内，常规治疗或常规治疗加免疫调理治疗对维持CD4／CD8的稳定具有同样价值，但是停免疫调理治疗后CD4／CD8则会出现下降趋势，原因不明，有待日后适当延长免疫调理疗程深入观察和探讨。
Objective To study the clinical effect of immune regulation therapy on trauma,severe sepsis and MODS patients, Methods Seventy patients conform to the standard of trauma,severe sepsis and MODS were analyzed prospectively. All patients were divided into two groups at random. One was contrast group with regular therapy. The other was treatment group with Ulinastatin plus Thymosin-etl in a week. The immune index before and after therapy in the 1 st,3rd,7th, 14th and 28th day,including the continue change of lymphocytes, CD4, CDs, CD4/CDs and monocytes HLA-DR CD14 were observed. Results Twenty patients died in the contrast group and thirteen patients died in the treatment group. It was significant difference between two groups, P 〈 0.05. CD4 in treatment group was significant higher than that in contrast group between the 7th and the 14th day of therapy, P 〈 0. 05. CDs in treatment group was significant higher than that in contrast group on the 14th day of therapy, P 〈 0.05. CD4/CD8 was no difference in two groups within 7 days of therapy, P 〉0. 05 ,but CD4/CD8 in treatment group decreased significantly after stopping immune regulation therapy, P 〈0. 05. Lymphocytes and monocytes HLA-DR CD14 were significant higher than those in contrast group after the 7th day of thera- py, which lasted till the 28th day. Conclusion Immune regulation can improve the prognosis of trauma, severe sepsis and MODS patients within 28 days and increase lymphocytes and monocytes HLA-DR CD14 significantly. It deserves recommendation for the clinic. The clinical effect of immune regulation therapy on the increase of CD4 and CDs is out of synchronic or delayed,which may be relative to the different time of immune response and/or two-ways regulation on the lymphocyte subgroup. Within 7 days of therapy, regular therapy or plus immune regulation therapy has the same value of maintaining the stabilization of CD4/CD8, but CD4/CD8 will decrease after stopping immune regulation therapy. The reason is unknown. It should be studied further after appropriately prolonging the course of immune regulation therapy.
出处
《中国实用外科杂志》
CSCD
北大核心
2006年第12期932-935,共4页
Chinese Journal of Practical Surgery
基金
2003年度广州市科委基金资助(基金编号:2003Z3-E0301)
