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目的探讨乌司他丁联合胸腺肽α1对T辅助细胞(Th)极化趋势的影响及对脓毒症免疫调理的作用。方法收集2006年10月-2007年10月在广州军区总医院ICU就诊的脓毒症患者60例,随机均分为治疗组(n=30)和对照组(n=30)。对照组给予经典SSC治疗,治疗组在SSC治疗的基础上加用乌司他丁和胸腺肽α1,并将对照组按照治疗28d时的生存状态进一步分为死亡亚组和存活亚组。于第1天(给药前)和第10天留取外周血,流式细胞仪检测CD4+T细胞亚群,半定量分析其中Th1型细胞因子IFN-γ和Th2型细胞因子IL-4的表达情况。同期选取10名健康人作为正常组。结果治疗组第10天时CD4+T细胞内IFN-γ和IL-4阳性表达率与给药前及对照组比较均明显下降(P<0.05),而IFN-γ/IL-4比值与给药前及对照组比较均明显升高(P<0.05)。对照组第10天时CD4+T细胞内IFN-γ和IL-4阳性表达率与给药前比较差异无统计学意义(P>0.05)。在对照组患者中,IFN-γ阳性率在存活亚组呈低水平,且在治疗前后呈下降趋势;在死亡亚组呈高水平,在治疗前后亦呈下降趋势。IL-4阳性率在存活亚组呈下降趋势,在死亡亚组呈上升趋势。结论乌司他丁联合胸腺肽α1可改善脓毒症患者的IFN-γ、IL-4比例失衡,调整机体免疫状态。
Objective To investigate the effect of ulinastatin combined with thymosin α1 on the polarization of T helper cells (Th) and its effect on immune regulation of sepsis. Methods Sixty patients with sepsis who were admitted to ICU of Guangzhou Military Region General Hospital from October 2006 to October 2007 were randomly divided into treatment group (n = 30) and control group (n = 30). The control group was treated with classic SSC. The treatment group was given ulinastatin and thymosin α1 on the basis of SSC treatment, and the control group was further divided into the death subgroup and the survival subgroup according to the survival status at the 28th day of treatment. Peripheral blood was collected on day 1 (before administration) and on day 10, and the CD4 + T cell subsets were detected by flow cytometry. The levels of Th1-type cytokines IFN-γ and Th2-type cytokines IL-4 Express the situation. Select the same period, 10 healthy people as a normal group. Results The positive rate of IFN-γ and IL-4 in CD4 + T cells in treatment group decreased significantly (P <0.05) compared with pre-treatment and control groups on day 10, while the ratio of IFN-γ / IL- Before and the control group were significantly higher (P <0.05). The positive rates of IFN-γ and IL-4 in CD4 + T cells in the control group on day 10 were not significantly different from those before administration (P> 0.05). In the control group, the positive rate of IFN-γ was low in the surviving subgroup and decreased before and after the treatment; it was high in the subgroup of death and also decreased before and after treatment. The positive rate of IL-4 showed a decreasing trend in the survival subgroup and a rising trend in the death subgroup. Conclusion Ulinastatin combined with thymosin α1 can improve the imbalance of IFN-γ and IL-4 in patients with sepsis and adjust the immune status.