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乌司他丁对严重多发伤患者早期炎症及T淋巴细胞免疫反应的影响及其临床价值
Effect of ulinastatin on early inflammatory and T lymphocyte immune responses in patients with severe multiple trauma and its clinical value
- 第三军医大学学报 2019年41卷第17期 页码：1666-1671
- 作者机构：
400038 重庆，陆军军医大学(第三军医大学)第一附属医院急救部
- 作者简介：
[ 刘明华，E-mail: mhliu4cq@aliyun.com LIU Minghua, E-mail: mhliu4cq@aliyun.com
- 基金信息：重庆市社会民生科技创新专项项目(CSTC2016SHMSZX130007)
DOI：10.16016/j.1000-5404.201906077
中图分类号： R642.05;R969.4;R977.6收稿：2019-06-08，
修回：2019-07-09，
纸质出版：2019-09-15
- 稿件说明：
移动端阅览
刘涵, 陈翔宇, 黄崧, 等. 乌司他丁对严重多发伤患者早期炎症及T淋巴细胞免疫反应的影响及其临床价值[J]. 第三军医大学学报, 2019,41(17):1666-1671.
Han LIU, Xiangyu CHEN, Song HUANG, et al. Effect of ulinastatin on early inflammatory and T lymphocyte immune responses in patients with severe multiple trauma and its clinical value[J]. Journal of Third Military Medical University, 2019, 41(17): 1666-1671.
刘涵, 陈翔宇, 黄崧, 等. 乌司他丁对严重多发伤患者早期炎症及T淋巴细胞免疫反应的影响及其临床价值[J]. 第三军医大学学报, 2019,41(17):1666-1671. DOI： 10.16016/j.1000-5404.201906077.
Han LIU, Xiangyu CHEN, Song HUANG, et al. Effect of ulinastatin on early inflammatory and T lymphocyte immune responses in patients with severe multiple trauma and its clinical value[J]. Journal of Third Military Medical University, 2019, 41(17): 1666-1671. DOI： 10.16016/j.1000-5404.201906077.
摘要
目的
2
探讨乌司他丁在严重多发伤患者早期炎症及T淋巴细胞免疫中的作用，并分析其临床价值。
方法
2
选取我科2016年1月至2019年1月收治的严重多发伤患者40例，采用随机数字表法分为对照组和乌司他丁治疗组(
n
=20)。对照组患者给予常规治疗；乌司他丁治疗组患者在其基础上，入院当天即开始连续7 d静脉滴注乌司他丁(100 kU、3次/d)，分别比较两组患者治疗前及治疗后第1、3、7天外周血T淋巴细胞亚群变化，以及肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、皮质醇及各临床相关指标的差异。
结果
2
与对照组患者比较，在治疗后第1、3、7天，乌司他丁治疗组患者CD3
+
、CD4
+
、CD4
+
/CD8
+
明显升高(
P
<
0.05)，TNF-α、IL-6及皮质醇水平显著降低(
P
<
0.05)，两组患者谷丙转氨酶(ALT)、尿素氮(BUN)、肌酐(Scr)值差异不明显；两组患者平均住院时间、入住ICU时间、并发症发生率间差异均有统计学意义(
P
<
0.05)，但病死率差异无统计学意义。
结论
2
乌司他丁应用于严重多发伤后早期，能促进T淋巴细胞亚群的恢复，减少炎症细胞因子的释放，抑制炎症反应，减少ICU入住和平均住院时间，降低并发症发生率，但不能改善病死率。
Abstract
Objective
2
To investigate the roles of ulinastatin in early inflammatory and T lymphocyte immune responses in patients with severe multiple trauma and analyze its clinical value.
Methods
2
Forty patients with severe multiple-trauma admitted in our center from January 2016 to January 2019 were enrolled in this study
and randomly divided into ulinastatin group (
n
=20) and control group (
n
=20). The patients of the control group were given conventional treatment
and those of the ulinastatin group were given an intravenous infusion of ulinastatin
100 kU
3 times per day
from the day of admission for 7 consecutive days besides conventional treatment. The counts of T lymphocyte subsets (CD3
+
and CD4
+
)
ratio of CD4
+
/CD8
+
levels of inflammatory factors (TNF-α and IL-6) and cortisol
and other clinical relevant indexes were measured and compared before treatment
on days 1
3 and 7 after treatment
respectively.
Results
2
The counts of CD3
+
and CD4
+
lymphocytes and the ratio of CD4
+
/CD8
+
were significantly higher in the ulinastatin group than the control group on days 1
3 and 7 after treatment (
P
<
0.05)
while the serum levels of TNF-α
IL-6 and cortisol were obviously lower (
P
<
0.05). There were no notable differences in the levels of alpha-alanine aminotransferase (ALT)
urea nitrogen (BUN) and creatinine (Scr) between the 2 groups. But significant differences were seen in the average length of hospital stay
length of ICU stay and incidence of complications between them (
P
<
0.05)
though no difference in mortality.
Conclusion
2
Ulinastatin can promote the recovery of T lymphocyte subsets
decrease the release of inflammatory cytokines and reduce the inflammatory response in early after severe multiple injuries
and thus can reduce the lengths of ICU stay and hospital stay and incidence of complications
but it has no effect on mortality.
关键词
Keywords
references
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