免疫调理对脓毒症免疫功能和预后的作用
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管向东

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The role of Immunomodulation on immune function and prognosis in sepsis
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    摘要:

    目的:探讨免疫调理对改善脓毒症大鼠和患者免疫功能及预后所起的作用。
    方法:(1)实验部分:将大鼠分为3组:假手术组、对照组和实验组,每组20只。后2组采用大鼠盲肠结扎穿孔的方法制备大鼠脓毒症模型,对照组接受抗生素治疗,实验组接受抗生素加免疫调理。制作模后分别在3,12,24,48 h采血。各组大鼠按时点进行淋巴细胞计数和测定CD4+,CD8+ T淋巴细胞和CD4/CD8比值;观察胸腺和脾脏淋巴细胞凋亡情况,计算脓毒症大鼠的存活率。(1)临床部分:前瞻性分析70例符合脓毒症患者,随机分成对照组和观察组。对照组接受经典治疗,观察组采用经典治疗联合蛋白酶抑制剂和胸腺肽α1治疗(经典治疗+免疫调理),免疫调理疗程为7 d,分别观察治疗前和治疗后1,3,7 d临床和相关免疫学指标。
    结果:(1)实验部分:CLP脓毒症造模成功后,实验组淋巴细胞,CD4+T淋巴细胞水平,CD4/CD8值均显著高于对照组明显(P<0.05)。对照组胸腺和脾脏的淋巴细胞凋亡指数比实验组明显增高(P<0.05)。实验组72 h存活时间比对照组明显延长(P<0.05)。(2)临床部分:观察组CD4+T淋巴细胞,淋巴细胞计数及CD14+单核细胞HLA-DR水平较对照组显著升高(P<0.05)。对照组死亡20例,观察组死亡13例(P<0.05)。
    结论:免疫调理可使脓毒症大鼠免疫功能提高,降低胸腺和脾脏淋巴细胞的凋亡率,提高脓毒症大鼠的存活率。免疫调理可提高脓毒症患者免疫调理的免疫功能,改善其免疫麻痹,延长近期生存率。

    Abstract:

    Objective:To study the effect of immunomodulation on improvement of immune function and prognosis in sepsis  in rats, and its mechanism.
    Methods:Experimental part: cecal ligation-perforation (CLP) models were divided into three groups including sham group (n=20), control group(n=20) and experimental group(n=20).Control group only used antibiotic and experimental group used antibiotic plus immunomodulation. Blood collections were made after CLP model at 3, 12, 48 and 72hr. Lymphocyte counting, CD4+, CD8+ T lymphocyte and CD4/CD8 ratio were checked. The apoptosis of lymphocyte in thymus and spleen and survival rate were checked. Clinical part: Prospective analysis of seventy patients who conformed to the sepsis standard. They were divided into two groups randomly. One was control group with regular therapy,  and the therapy group with ulinastatin plus thymosin-α1 for 7days. The immune index before and after therapy at 0, 1d, 3d, and 7d was observed, including the clinical changes and survival data.
    Results:Experimental part: Lymphocytes, CD4+ T lymphocytes and CD4/CD8 ratio in experimental group increased more significantly than in control group(P<0.05). Lymphocyte apoptosis index of thymus and spleen in control group increased more significantly than in experimental group(P<0.05).Seventy-two hour survival in experimental group was longer than in control group. Clinical part: CD4+T lymphocytes, lymphocytes and monocytes HLA-DR CD14+ were more significantly increased in therapy group than that in control group(P<0.05).During hospitalization, twenty patients died in the control group and thirteen patients died in the therapy group(P<0.05).
    Conclusions:Immunomodulation in septic rat can improve immune function, alleviate the lymphocyte apoptosis of thymus and spleen and increase the survival time. Immunomodulation in septic patients can improve the immune paralysis and prolong survival.

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黄顺伟, 管向东, 陈娟, 欧阳彬, 杨春华, 陈敏.免疫调理对脓毒症免疫功能和预后的作用[J].中国普通外科杂志,2009,18(9):926-931.
DOI:10.7659/j. issn.1005-6947.2009.09.010

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  • 收稿日期:2009-03-25
  • 最后修改日期:2009-07-24
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  • 在线发布日期: 2009-09-15