目的 探讨胸腺法新对重症肺炎患者免疫功能及炎性反应的影响.方法 选取2015年6月至2018年6月于武警浙江省总队医院住院治疗的重症肺炎患者86例为研究对象,按照治疗方法不同将其分为对照组与治疗组各43例.对照组于常规治疗基础上采用头孢哌酮/舒巴坦钠治疗;治疗组于对照组治疗基础上采用胸腺法新治疗.检测两组患者治疗前后外周血单核细胞人白细胞抗原-DR (mHLA-DR)表达和肿瘤坏死因子α(TNF-α)及白细胞介素6(IL-6)水平.同时检测两组患者治疗前后CD4+、CD8+、CD4 +/CD8+情况.评价两组疗效及细菌清除率并记录不良反应发生情况.结果 两组患者治疗后IL-6、TNF-α水平均明显低于治疗前[治疗组:(44.9±11.8) ng/L、(42.9±13.1) ng/L比(86.5±27.9) ng/L、(79.6±28.6) ng/L),对照组:(71.5±14.2)ng/L、(65.9±22.6) ng/L比(87.1±28.6)ng/L、(78.8±29.1) ng/L),t=9.005、7.650、3.203、2.295,均P＜0.05].治疗组mHLA-DR表达水平[(44.8±5.7)％]明显高于治疗前[(27.1±3.4)％](t=17.487,P=0.000).而治疗组各项指标均优于对照组,差异均有统计学意义(t=9.447、5.773、8.725,均P＜0.05).两组患者治疗后CD4+较治疗前均升高,CD8+较治疗前均明显下降(t=3.050、3.429、6.965、13.327,均P＜0.05),而CD4 +/CD8+均明显升高(t=0.370、3.314,均P＜0.05),治疗组各项指标改善均更显著(t =4.416、12.355、3.089,均P＜0.05).治疗组细菌清除率为88.89％(32/36),明显高于对照组的67.65％ (23/34)(x2=4.686,P=0.030).治疗组总有效率为93.02％ (40/43),明显高于对照组的76.74％(33/43)(x2=6.095,P=0.047).两组不良反应发生情况差异无统计学意义(x2=0.212,P=0.645).结论 胸腺法新治疗重症肺炎可提高患者免疫功能、减轻炎性反应、提高细菌清除率及临床疗效,且不会增加不良反应发生.“,”Objective To explore the clinical efficacy of thymalfasin on the immune function and inflammatory response in the treatment of patients with severe pneumonia.Methods From June 2015 to June 2018,86 patients with severe pneumonia in the Hospital of Zhejiang Provincial General Team of Armed Police were enrolled in the study.According to different treatment methods,they were divided into control group and treatment group,with 43 cases in each group.The control group was treated with cefoperazone/sulbactam sodium on the basis of conventional treatment.The treatment group was treated with thymalfasin on the basis of the treatment of the control group.The expression of monocyte human leukocyte antigen-DR (mHLA-DR),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured before and after treatment.At the same time,CD4+,CD8+,CD4+ /CD8 + before and after treatment were examined in the two groups.The efficacy and bacterial clearance rate of the two groups were evaluated.The adverse reactions were recorded.Results After treatment,the levels of IL-6 and TNF-α in the two groups were significantly lower than those before treatment [treatment group:(44.9 ± 11.8)ng/L,(42.9 ± 13.1) ng/L vs.(86.5 ± 27.9) ng/L,(79.6 ± 28.6) ng/L,control group:(71.5 ± 14.2)ng/L,(65.9 ±22.6)ng/L vs.(87.1 ±28.6)ng/L,(78.8 ±29.1)ng/L,t =9.005,7.650,3.203,2.295,all P ＜ 0.05].The expression level of mHLA-DR in the treatment group after treatment [(44.8 ± 5.7) ％] was significantly higher than that before treatment [(27.1 ± 3.4) ％,t =17.487,P =0.000].The changes of the indicators in the treatment group were significantly better than those in the control group (t =9.447,5.773,8.725,all P ＜ 0.05).After treatment,the CD4+ level of the two groups were higher than those before treatment,and the CD8+ levels of the two groups were significantly lower than those before treatment,the differences were statistically significant(t =3.050,3.429,6.965,13.327,all P ＜ 0.05),and the CD4 +/CD8 + of the two groups were significantly increased (t =0.370,3.314,all P ＜0.05).The indicators of the treatment group were improved more significantly than the control group (t =4.416,12.355,3.089,all P ＜ 0.05).The bacterial clearance rate of the treatment group was 88.89％ (32/36),which was significantly higher than that of the control group [67.65％ (23/34),x2 =4.686,P =0.030].The clinical efficacy of the treatment group was 93.02％ (40/43),which was significantly higher than 76.74％ (33/43) of the control group (x2 =6.095,P =0.047).The incidence of adverse reactions between the two groups had no statistically significant difference (x2 =0.212,P =0.645).Conclusion Thymalfasin in the treatment of patients with severe pneumonia can improve the immune function,reduce the inflammatory response,improve the bacterial clearance rate and clinical efficacy,and will not increase the adverse reactions,so it is worthy of promoting.