生长抑素对腹腔疾病引起的严重脓毒症双向免疫调节作用的研究

目的 探讨生长抑素对严重腹腔脓毒症患者免疫炎性反应紊乱及预后的影响.方法 将2005年6月至2009年6月收治的53例年龄＞18岁、急性生理和慢性健康状况(APACHEⅡ)评分＞15分的严重腹腔脓毒症患者随机分为生长抑素组(n=23例)和经典治疗组(n=30例),选取同期年龄匹配的15名健康体检者作为对照组.经典治疗组给予经典拯救脓毒症运动治疗;生长抑素组在经典拯救脓毒症运动治疗的基础上联合运用14肽生长抑素(生长抑素)6 mg/24 h持续给药,连续7 d.观察比较患者入院时(d1)及治疗后第3天(d3)、第7天(d7)和第14天(d14)血清白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平和T细胞亚群CD4+、CD8+和CD4+/CD8+以及APACHEⅡ评分的动态变化和28 d病死率.结果 与对照组比较,严重腹腔脓毒症患者血清IL-10和TNF-α水平明显升高(P＜0.05),CD4+、CD8+和CD4+/CD8+明显降低(P＜0.05);与经典治疗组同期比较,生长抑素组d7、d14、CD4+、CD8+和CD4+/CD8+明显升高(P＜0.05),IL-10和TNF-α均明显下降(P＜0.05);生长抑素组d3、d7、d14的APACHE-Ⅱ评分较经典治疗组明显降低(P＜0.05);28 d内机械通气时间、ICU停留时间有所缩短,28 d病死率有所下降,但差异无统计学意义(P＞0.05).结论 严重腹腔脓毒症患者全身炎症反应和免疫抑制同时存在;生长抑素具有抗炎和免疫增强双向调节作用.

Dual regulation effect of somatostatin on immunity in patients with severe sepsis caused by abdominal diseases

Objective To investigate the effect of somatostatin on inflammatory immune disorders and prognosis in patients with severe sepsis caused by abdominal diseases. Methods Fifty-three patients with severe abdominal sepsis (age ＞ 18 years, APACHE-Ⅱ score ＞ 15 ) from June 2005 to June 2009 were randomly divided into Somatostatin group ( n = 23 ) and SSC Group ( n = 30). Fifteen healthy volunteers of the same age range were chosen as Control group. The SSC group was treated with classical SSC therapy, and the Somatostatin Group was treated with the same regime plus 14-peptide somatostatin continuous infusion at the dose of 6 mg/24 h for 7 days. The serum levels of interleukin -10 (IL-10), tumor necrosis factor-α (TNF-α) were determined by using ELISA. CD4+, CD8+ T cell subsets were determined by fluorescence activated cell sorter(FACS) and CD4+/CD8+ was calculated. APACHE-Ⅱ score was observed on admission ( dl ) and day 3, 7 and 14 after treatment. Morality rates in 28 days in two groups were recorded. Results Compared with Control group, IL-10 and TNF-α levels were significantly elevated in patients with severe abdominal sepsis (P ＜0. 05), while CD4+, CD8+ T cell and CD4+/CD8+ decreased significanfly(P＜0. 05). Compared with the Somatostatin group CD4+, CD8+ T cell and CD4+/CD8+ on d7 and d14 in SSC Group were significantly increased ( P ＜ 0. 05 ), while IL-10 and TNF-α decreased significantly( P ＜0. 05 ). APACHE-Ⅱ scores on d3, d7, d14 of Somatostatin group were significantly lower than those of SSC group, and 28 d mortality rate also declined. Conclusions In patients with severe abdominal sepsis, systemic inflammatory response and immune suppression exist simultaneously.Somatostatin has a dual immunomodulatory activity in these patients.