参附注射液对严重创伤患者T细胞亚群、天然杀伤细胞及预后的影响
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摘要
目的探讨对严重创伤患者行参附注射液后外周血T细胞亚群和天然杀伤细胞(NK细胞)的变化,从而观察其对ICU治疗时间、多器官功能障碍综合征(MODS)发生率及病死率的影响。方法将60例严重创伤患者随机分为对照组(30例)和参附治疗组(30例),同期选取30例健康体检者为健康对照组。对照组患者给予常规诊治,参附治疗组患者则在常规救治的基础上早期加用参附注射液治疗。采用流式细胞技术测定患者治疗前、治疗后3 d和7 d的外周血T细胞亚群的CD3~+、CD4~+、CD8~+和NK细胞的数量。并观察2组重症监护病房(ICU)治疗时间、MODS发生率及病死率。结果两治疗组CD3~+、CD4~+、CD8~+和NK细胞及CD4~+/CD8~+比值明显低于健康对照组(P<0.05)。治疗3 d,参附组CD3~+、CD4~+、CD8~+和NK细胞及CD4~+/CD8~+比值均明显升高(P<0.05)。治疗7 d,两治疗组CD3~+、CD4~+、CD8~+和NK细胞及CD4~+/CD8~+比值均明显升高(P<0.05)。参附组CD3~+、CD4~+、CD8~+和NK细胞及CD4~+/CD8~+比值明显高于对照组(P<0.05)。参附组ICU治疗时间、MODS发生率、病死率均明显低于对照组(P<0.05)。结论严重创伤患者在常规救治的基础上早期使用参附注射液,明显改善T细胞亚群和NK细胞的免疫障碍,从而缩短ICU住院时间,降低多器官功能障碍综合征发生率及病死率。
Objective To investigate the effect of Shenfu injection on T-lymphocyte subsets and natural killer( NK) cells in severe trauma patients and the influence of ICU treatment time,multiple organ dysfunction syndrome( MODS) incidence rate and mortality. Methods Sixty severe trauma patients were divided into the control group( n = 30) and shenfu group( n = 30). Other 30 cases were chosen as health control group at the same phase. All patients were received conventional treatments,however,the shenfu group patients were additionally received the shenfu injection treatment in the early stage. The T-lymphocyte subsets( CD3~+,CD4~+,CD8~+) and NK cells were detected on 3rd and 7th day by flow cytometry. The ICU treatment time,MODS incidence rate and mortality were surveyed. Results Compared to health control group,the T-lymphocyte subsets and NK cell counts were significantly low in treatment groups before received treatment.On 3rd treatment day,the CD3~+,CD4~+,CD8~+T-lymphocytes,NK cells and CD4~+/ CD8~+rate in shenfu group were significantly raised( P < 0. 05). On 7th treatment day,the CD3~+,CD4~+,CD8~+T-lymphocytes,NK cells and CD4~+/ CD8~+rate in shenfu and control group were significantly higher than health control group( P < 0. 05). The ICU treatment time,MODS incidence rate and mortality in shenfu group were significantly lower than control group( P < 0. 05). Conclusion Base on conventional therapy,the early use of shenfu injection can significantly improve immune dysfunction of the T-lymphocyte subset and NK cell in severe trauma patients,so that the ICU treatment time,MODS incidence rate and mortality were reduced.
Objective To investigate the effect of Shenfu injection on T-lymphocyte subsets and natural killer( NK) cells in severe trauma patients and the influence of ICU treatment time,multiple organ dysfunction syndrome( MODS) incidence rate and mortality. Methods Sixty severe trauma patients were divided into the control group( n = 30) and shenfu group( n = 30). Other 30 cases were chosen as health control group at the same phase. All patients were received conventional treatments,however,the shenfu group patients were additionally received the shenfu injection treatment in the early stage. The T-lymphocyte subsets( CD3~+,CD4~+,CD8~+) and NK cells were detected on 3rd and 7th day by flow cytometry. The ICU treatment time,MODS incidence rate and mortality were surveyed. Results Compared to health control group,the T-lymphocyte subsets and NK cell counts were significantly low in treatment groups before received treatment.On 3rd treatment day,the CD3~+,CD4~+,CD8~+T-lymphocytes,NK cells and CD4~+/ CD8~+rate in shenfu group were significantly raised( P < 0. 05). On 7th treatment day,the CD3~+,CD4~+,CD8~+T-lymphocytes,NK cells and CD4~+/ CD8~+rate in shenfu and control group were significantly higher than health control group( P < 0. 05). The ICU treatment time,MODS incidence rate and mortality in shenfu group were significantly lower than control group( P < 0. 05). Conclusion Base on conventional therapy,the early use of shenfu injection can significantly improve immune dysfunction of the T-lymphocyte subset and NK cell in severe trauma patients,so that the ICU treatment time,MODS incidence rate and mortality were reduced.
引文
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[14]Focosi D,Bestagno M,Burrone O,et al.CD57+T lymphocytes and functional immune deficiency[J].Journal of leukocyte biology,2010,87(1):107-116.
[15]Wang P,Kan QC,Yu ZJ,et al.Effects of cefodizime on chemokines of liver tissues in mice with immunological hepatic injury[J].China Med J,2011,124(5):746-750.
[16]D’Acquisto F,Crompton T.CD3+CD4+CD8+(double negative)T cells:saviours or villains of the immune response?[J].Biochemical pharmacology,2011,82(4):333-340.
[17]王滨,边瑞民,魏传梅,等.头孢地嗪增加老年细菌性肺炎患者外周血CD4/CD8和Th1/Th2细胞比例[J].细胞与分子免疫学杂志,2015,31(4):528-531.
[18]Vacca P,Martini S,Garelli V,et al.NK cells from malignant pleural effusions are not anergic but produce cytokines and display strong antitumor activity on short-term IL-2 activation[J].European journal of immunology,2013,43(2):550-561.
[19]Kumar P,Thakar MS,Ouyang W,et al.IL-22 from conventional NK cells is epithelial regenerative and inflammation protective during influenza infection[J].Mucosal immunology,2013,6(1):69-82.
[20]王宇.多发伤或严重创伤后淋巴细胞亚群的变化[D].上海:第二军医大学,2011.
[21]Tian H,Zhang M,Du C,et al.Effects of Rhubarb combined with ulinastatin on T-cell subsets in sepsis rats[J].International journal of clinical and experimental medicine,2015,8(1):1234.
[22]张伟军.参附注射液对感染性休克患者早期乳酸清除率的影响[J].甘肃医药,2015,34(1):56-57.
[23]徐丹,范颖.参附汤方源考证及其配伍内涵探析[J].中华中医药学刊,2010,28(5):1062-1063.
[24]王文龙.参附注射液治疗脓毒性休克作用机理分析[J].新中医,2015,47(3):3-5.
[25]刘学政,李桂伟.参附注射液治疗休克的临床研究[J].天津中医药大学学报,2012,31(1):12-13.
[26]张宁,邱泽亮,叶一萍,等.参附注射液对严重脓毒症患者炎症细胞因子和预后的影响[J].中华中医药学刊,2011,29(3):525-527.
[27]邱泽亮,叶一萍,张宁,等.参附注射液对严重脓毒症免疫调节的前瞻性研究[J].中华中医药学刊,2012,30(2):363-366.
[28]宁易平,邱泽亮,牟莉,等.参附注射液对严重脓毒症病人T细胞亚群及天然杀伤细胞的影响[J].中华中医药学刊,2013,31(10):2270-2272.
[2]Manson J,Thiemermann C,Brohi K.Trauma alarmins as activators of damage-induced inflammation[J].British Journal of Surgery,2012,99(S1):12-20.
[3]Uddin M,Aiello AE,Wildman DE,et al.Epigenetic and immune function profiles associated with posttraumatic stress disorder[J].Proceedings of the National Academy of Sciences,2010,107(20):9470-9475.
[4]Kawamura N,Kim Y,Asukai N.Suppression of cellular immunity in men with a past history of posttraumatic stress disorder[J].American Journal of Psychiatry,2001,158(3):484-486.
[5]刀敏,高静波,赵弼武.重度创伤后全身炎性反应综合征和多器官功能障碍综合征的临床分析[J].中国社区医师,2015,31(2):66,68.
[6]Shen YF,Cui NQ,Miao B,et al.Immune dysregulation in patients with severe acute pancreatitis[J].Inflammation,2011,34(1):36-42.
[7]白冰心,吴言为,张路瑶,等.脓毒症的免疫治疗进展[J].中国新药与临床杂志,2015,34(3):161-166.
[8]耿延青.脓毒症患者血中CD4+-CD25+-调节性T细胞水平与机体细胞免疫状态的相关性研究[J].中国医药导报,2015,12(3):7-10,23.
[9]赵旭明,秦陈浩,刘励军,等.严重创伤患者免疫功能抑制的影响因素[J].江苏医药,2014,40(7):785-788.
[10]Marik PE,Flemmer M.The immune response to surgery and trauma:Implications for treatment[J].Journal of Trauma and Acute Care Surgery,2012,73(4):801-808.
[11]Kimura F,Shimizu H,Yoshidome H,et al.Immunosuppression following surgical and traumatic injury[J].Surgery today,2010,40(9):793-808.
[12]I Ramzy A,Karmy-Jones R,B Long W.Chest Trauma:The Role of Injury Severity Scoring[J].Current Respiratory Medicine Reviews,2015,11(1):3-7.
[13]刘慧琳,刘桂花,田兆兴.脓毒症患者血中淋巴细胞水平的变化[J].中华危重病急救医学,2014,26(3):148-152.
[14]Focosi D,Bestagno M,Burrone O,et al.CD57+T lymphocytes and functional immune deficiency[J].Journal of leukocyte biology,2010,87(1):107-116.
[15]Wang P,Kan QC,Yu ZJ,et al.Effects of cefodizime on chemokines of liver tissues in mice with immunological hepatic injury[J].China Med J,2011,124(5):746-750.
[16]D’Acquisto F,Crompton T.CD3+CD4+CD8+(double negative)T cells:saviours or villains of the immune response?[J].Biochemical pharmacology,2011,82(4):333-340.
[17]王滨,边瑞民,魏传梅,等.头孢地嗪增加老年细菌性肺炎患者外周血CD4/CD8和Th1/Th2细胞比例[J].细胞与分子免疫学杂志,2015,31(4):528-531.
[18]Vacca P,Martini S,Garelli V,et al.NK cells from malignant pleural effusions are not anergic but produce cytokines and display strong antitumor activity on short-term IL-2 activation[J].European journal of immunology,2013,43(2):550-561.
[19]Kumar P,Thakar MS,Ouyang W,et al.IL-22 from conventional NK cells is epithelial regenerative and inflammation protective during influenza infection[J].Mucosal immunology,2013,6(1):69-82.
[20]王宇.多发伤或严重创伤后淋巴细胞亚群的变化[D].上海:第二军医大学,2011.
[21]Tian H,Zhang M,Du C,et al.Effects of Rhubarb combined with ulinastatin on T-cell subsets in sepsis rats[J].International journal of clinical and experimental medicine,2015,8(1):1234.
[22]张伟军.参附注射液对感染性休克患者早期乳酸清除率的影响[J].甘肃医药,2015,34(1):56-57.
[23]徐丹,范颖.参附汤方源考证及其配伍内涵探析[J].中华中医药学刊,2010,28(5):1062-1063.
[24]王文龙.参附注射液治疗脓毒性休克作用机理分析[J].新中医,2015,47(3):3-5.
[25]刘学政,李桂伟.参附注射液治疗休克的临床研究[J].天津中医药大学学报,2012,31(1):12-13.
[26]张宁,邱泽亮,叶一萍,等.参附注射液对严重脓毒症患者炎症细胞因子和预后的影响[J].中华中医药学刊,2011,29(3):525-527.
[27]邱泽亮,叶一萍,张宁,等.参附注射液对严重脓毒症免疫调节的前瞻性研究[J].中华中医药学刊,2012,30(2):363-366.
[28]宁易平,邱泽亮,牟莉,等.参附注射液对严重脓毒症病人T细胞亚群及天然杀伤细胞的影响[J].中华中医药学刊,2013,31(10):2270-2272.
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