参附注射液对严重脓毒症免疫调节的前瞻性研究

目的:观察参附注射液对严重脓毒症患者的免疫调节作用。方法:将68例严重脓毒症患者随机分为参附注射液加常规治疗组(简称参附组,36例)和单纯常规治疗组(简称对照组,32例)。分别于治疗前及治疗后3、7天进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEII)评分和Marshall评分,检测CD3+、CD4+、CD8+T淋巴细胞、单核细胞人白细胞DR抗原(HLA-DR)及血清白介素-6(IL-6)、IL-10和C-反应蛋白(CRP)水平。结果:两组患者治疗前APACHE II评分、Marshall评分、IL-6和IL-10水平的差异无统计学意义(P0.05);与健康对照组比较,严重脓毒症患者血清IL-6、IL-10和CRP水平明显升高,CD3+、CD4+、CD8+T淋巴细胞和单核细胞HLA-DR表达明显降低(P0.05)。与对照组同期比较,治疗后7天参附组APACHEII、Marshall评分及IL-6和CRP水平均明显下降,而CD3+、CD4+、CD8+T淋巴细胞和单核细胞HLA-DR均明显升高,差异均有统计学意义(P0.05)。结论:严重脓毒症患者全身炎症反应和免疫抑制同时存在;参附注射液具有维持促炎/抗炎平衡,双向调节严重脓毒症免疫紊乱作用,从而改善临床疗效。

Effects of Shenfu Injection on the Modulation of Immunity in Patients with Severe Sepsis:A Prospective Clinical Trial

Objective:To observe the role of Shengfu injection(SFI) on the modulation of immunity in patients with severe sepsis.Methods:Sixty-eight patients with severe sepsis were randomly divided into two groups,36 patients in Shenfu group were treated with SFI at the base of conventional therapy and 32 patients in the control group were treated with conventional therapy of western medicine alone.The acute physiology and chronic health evaluation II(APACHE II) score and Marshall score were observed.The serum levels of interleukins(IL-6,IL-10),C-reactive protein,CD+3,CD+4,CD+8T cell and monocyte human leukocyte antigen-DR(HLA-DR) before and 3,7 days after treatment were observed.Results:There were insignificant difference of the APACHE II score,Marshall score,IL-6 and IL-10 between Shenfu group and control group before any treatment(P>0.05).The levels of serum IL-6,IL-10 and CRP before treatment in both the groups were all significantly higher,and the CD+3,CD+4,CD+8T lymphocyte numbers and the HLA-DR level were all significantly lower than those of healthy controls(P<0.05).Compared with the control group,scores of APACHE II and Marshall and the levels of serum IL-6 and CRP in the Shenfu group were decreased significantly at 7 days after treatment,while the CD+3,CD+4,CD+8T lymphocyte numbers were increased significantly at the same time(P<0.05).Conclusions:Systemic inflammatory response and immunodepression exist in severe sepsis simultaneously.SFI cannot only keep proinflammatory and anti-inflammatory cytokines on the balance,but also play a role in bi-modulate the immune turbulence,so as to improve the clinical therapeutic efficacy.