胸腺肽α_1在四川汶川地震挤压伤伴重症感染、脓毒症患者中的应用
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摘要
目的:观察胸腺肽α1(thymosinα1)对挤压伤伴重度感染、脓毒症患者应用后细胞免疫功能障碍及预后的影响。方法:回顾性选择我院爱心病房2008年5月28-7月31日救治四川汶川地震灾区挤压伤6例伴重症感染、脓毒症患者。在给予积极创面治疗的同时,按病原菌抗生素敏感试验选择敏感抗生素进行抗感染治疗,营养支持及其他对症综合治疗措施外,加用免疫调节剂胸腺肽α1。在治疗前和治疗过程中进行血常规和T淋巴细胞亚群的监测,以评估胸腺肽α1治疗在地震挤压伤伴重度感染、脓毒症患者应用后细胞免疫功能障碍及对预后的影响。结果:经综合治疗后,其中2例极危重挤压综合征患者临床转归达治愈,其余4例伴重度感染、脓毒症患者病情稳定,阻断其发展为多器官功能衰竭。治疗前,所有患者白细胞(Whiteblood cell,WBC)和中性粒细胞(neutrophil,NEUT)有异常增高,治疗后患者异常增高WBC和NEUT明显下降(P<0.05);治疗后患者CD3和CD4淋巴细胞亚群水平有升高趋势;CD4/CD8的比值治疗后较治疗后前有所下降,但无统计学意义(P>0.05)。结论:免疫调节剂胸腺肽α1综合内、外科治疗措施应用于挤压伤伴重度感染、脓毒症患者,可增加CD3、CD4淋巴细胞亚群,下调CD4/CD8比值的趋势,从而减轻全身炎症反应,对患者的预后改观起到一定的作用。
OBJECTIVE To observe the medical effect of thymosinα1 to the cell immunal disfunction and prognosis in crush syndrome patients with severe infection or sepsis.METHODS 6 patients who were treated in department of combination,renji hospital,coming from earthquake area of Wenchuan county in Sichuan province,they had crush injury with servere infection or sepsis.The patients were treated positively with the injured area,the suitable antibiotics were used to them according to the antimicrobial susceptibility test,besides nutrition support and relieving symptoms treatment,thymosinα1 were also used to them.Two extremely serious patients were given thymosinα1 1.6 mg qd intramuscular injection.We adjusted dosage,frequency,course treatment,according to the change of illness.The course is from 12-26 days,average 21 days.Blood cell counting and T lymphocyte subgroup were monitored before and after treatment,which helped to assess regulatory effect of thymosinα1in earthquake crush syndrome patients with severe infection and sepsis and its influence to the prognosis.RESULTS After combined therapy,two extremely serious crush syndrome patients were cured clinically,four crush injury patients with server infection or sepsis turned to stabile condition and didn't develop to multiple organ failure.Before treatment,WBC and neutrocyte counts were all abnormally increased in all the patients,which were normally decreased after treatment(P<0.05);after treatment,the level of CD3 and CD4 T lymphocyte subgroup had increasing trend,the ratio of CD4/CD8 had decreasing trend,but no statistical significance were obtained(P>0.05).CONCLUSION Employing immunomodulator-thymosinα1will up-regulate CD3 and CD4 T lymphocyte subgroup and down-regulate the ratio of CD4/CD8 in crush injury patient with severe infection or sepsis,who were treated with the combination of internal medicine and surgical therapy,thus to relieve systemic inflammatory response and play some role in patients'prognosis.
OBJECTIVE To observe the medical effect of thymosinα1 to the cell immunal disfunction and prognosis in crush syndrome patients with severe infection or sepsis.METHODS 6 patients who were treated in department of combination,renji hospital,coming from earthquake area of Wenchuan county in Sichuan province,they had crush injury with servere infection or sepsis.The patients were treated positively with the injured area,the suitable antibiotics were used to them according to the antimicrobial susceptibility test,besides nutrition support and relieving symptoms treatment,thymosinα1 were also used to them.Two extremely serious patients were given thymosinα1 1.6 mg qd intramuscular injection.We adjusted dosage,frequency,course treatment,according to the change of illness.The course is from 12-26 days,average 21 days.Blood cell counting and T lymphocyte subgroup were monitored before and after treatment,which helped to assess regulatory effect of thymosinα1in earthquake crush syndrome patients with severe infection and sepsis and its influence to the prognosis.RESULTS After combined therapy,two extremely serious crush syndrome patients were cured clinically,four crush injury patients with server infection or sepsis turned to stabile condition and didn't develop to multiple organ failure.Before treatment,WBC and neutrocyte counts were all abnormally increased in all the patients,which were normally decreased after treatment(P<0.05);after treatment,the level of CD3 and CD4 T lymphocyte subgroup had increasing trend,the ratio of CD4/CD8 had decreasing trend,but no statistical significance were obtained(P>0.05).CONCLUSION Employing immunomodulator-thymosinα1will up-regulate CD3 and CD4 T lymphocyte subgroup and down-regulate the ratio of CD4/CD8 in crush injury patient with severe infection or sepsis,who were treated with the combination of internal medicine and surgical therapy,thus to relieve systemic inflammatory response and play some role in patients'prognosis.
引文
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[2]林洪远,郭旭生,姚咏明,等.CD14+单核细胞人类白细胞抗原-DR预测脓毒症预后及指导免疫调理治疗的初步临床研究[J].中国危重病急救医学,2003,15:135-138.
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[6]朱海红,陈建忠,陈智,等.胸腺肽α1对人淋巴细胞抗感染相关的信号转导分子的表达[J].中华传染病杂志,2003,21:221-224.
[7]郭世春,吴蕊,王国俊,等.医院下呼吸道感染患者T细胞亚群白细胞介素2活性测定[J].中华医院感染学杂志,2002,12:27-28.
[2]林洪远,郭旭生,姚咏明,等.CD14+单核细胞人类白细胞抗原-DR预测脓毒症预后及指导免疫调理治疗的初步临床研究[J].中国危重病急救医学,2003,15:135-138.
[3]Oberholzer C,Oberholzer A,Clare-Salzler M,et al.Apoptosisin sepsis:a newtarget for therapeutic exploration[J].Faseb J,2001,15:879-892.
[4]Hotchkiss RS,Karl JE.The pathophysiology and treat ment ofsepsis[J].N Engl J Med,2003,348:138-150.
[5]Baumann CA,Badamchian M,Goldstein AL.Thymosin alpha1is a ti me and dose-dependent antagonist of dexamethasone-in-duced apoptosis of murine thymocytes in vitro[J].Int J I m-munopharmacol,2000,22:1057-66.
[6]朱海红,陈建忠,陈智,等.胸腺肽α1对人淋巴细胞抗感染相关的信号转导分子的表达[J].中华传染病杂志,2003,21:221-224.
[7]郭世春,吴蕊,王国俊,等.医院下呼吸道感染患者T细胞亚群白细胞介素2活性测定[J].中华医院感染学杂志,2002,12:27-28.
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