血必净注射液在重症肺炎中对机体免疫功能的调控研究

目的观察应用血必净注射液对重症肺炎患者血清中白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-a(TNF-a)水平以及外周血中CD4~+T、CD8~+T细胞频率变化,以明确其对机体免疫功能的影响。方法收集武汉大学人民医院ICU的46例需要机械通气的重症肺炎患者,应用随机方法分为血必净组各23例,两组患者基本治疗均予以积极液体复苏、抗感染、机械通气、维持水电解质平衡及营养支持等综合治疗。血必净组患者在上述综合治疗基础上加用血必净静脉输注治疗,用法为血必净100m L加入100m L生理盐水中,使用频率为q12h,连续应用7d。收集患者治疗前后外周静脉血,应用ELISA方法测定血清中IL-6、IL-10、TNF-a分子水平,应用FACS方法测定外周血单个核细胞(PBMCs)中CD4~+T、CD8~+T细胞频率的变化。同时监测治疗前后患者血气分析、胸片、应用呼吸机时间等变化,评价其治疗效果。结果血必净组与对照组相比,其血清中IL-6、TNF-a水平在血必净组较对照组显著降低,差异具有统计学意义(P0.05);IL-10水平在血必净治疗组较对照组升高,差异具有统计学意义(P0.01);CD4~+T、CD8~+T细胞频率在血必净治疗组较对照组均升高,差异具有统计学意义(P0.01)。血必净治疗组患者应用呼吸机时间较对照组患者明显缩短,差异具有统计学意义(P0.01);两组患者氧合指数(PaO_2/FiO_2)治疗后均有明显改善,但血必净治疗组较对照组改善效果更为显著,血必净治疗组急性生理与慢性健康评分(APACHE II)较对照组降低,临床肺部感染评分(CPIS)较对照组降低,差异均具有统计学差异(P0.01或P0.05)。结论应用血必净治疗能够明显改善机体免疫功能,控制肺部炎症反应,提高治疗效果。

The Effects of Xuebijing Injection on Immune Function in Severe Pneumonia

Objective To evaluate the effect of Xuebijing Injection on immune function in the patients with severe pneumonia by detecting the serum levels of IL-6,IL-10 and TNF-a and the frequencies of CD4+ T and CD8+ T cells in peripheral blood in patients with severe pneumonia.Methods 46 patients with severe pneumonia who needed mechanical ventilation in ICU of Renmin Hospital were randomly divided into Xuebijing group (n =23) and the control group (n =23).Both groups were treated with active liquid resuscitation,anti-infection,mechanical ventilation,maintenance of water and electrolyte balance,nutritional support and other comprehensive treatment.The Xuebijing injection were also used on the basis of comprehensive treatment in Xuebijing group.100mL Xuebijing injection was mixed with 100mL physiological saline and dropped intravenously,12 hours per time,continusly treated for 7 days.The levels of IL-6,IL-10 and TNF-a in serum were measured by ELISA and the frequencies of CD4+ T and CD8+ T cells in peripheral blood cells were detected by FACS.To evaluate the therapeutic effect,the blood gas analysis,chest X-ray,ventilator time and other changes were monitored monitor before and after treatment.Results The levels of IL-6 and TNF-a in serum in Xuebijing group were significantly decreased compared with control group,and the differences were statistically significant (P ＜0.01).The levels of IL-10 in serum in Xuebijing group was increased compared with control group (P＜0.05).The frequencies ofCD4+ T and CD8+ T cells in Xuebijing group were both increased compared with control group (P ＜0.01).The oxygenation index (PaO2 / FiO2) of both groups was improved after treatment,and the therapeutic effect of Xuebijing group was more significantly.The APACHE Ⅱ score after treatment was lower in Xuebijing group than in the control group.The CPIS score after treatment was lower in Xuebijing group than that in control group.The differences were statistically significant (P＜0.01 orP ＜0.05).Conclusion The application of Xuebijing treatment can significantly improve the immune function of patients with severe pneumonia,control the inflammation in the lung and improve the therapeutic effect.