乌司他丁治疗百草枯中毒患者的临床疗效及对炎性细胞因子、T淋巴细胞亚群的影响

目的 通过探讨百草枯中毒患者血浆中白细胞介素8（interleukin-8，IL-8）、肿瘤坏死因子α(tumor necrosis factor-α，TNF-α)、基质金属蛋白酶9（matrix metalloproteinase-9，MMP-9）和T淋巴细胞亚群的变化以及乌司他丁对其的影响，研究乌司他丁对百草枯中毒的疗效，并为其治疗提供新的方法。 方法 选择符合标准的急性百草枯中毒患者80例，随机分为2组：对照组40例、治疗组40例。对照组患者进行基础治疗，治疗组患者除基础治疗外，还给予乌司他丁治疗，观察2组患者治疗14 d的临床指标，并留取7 d、14 d血液标本，检测血浆中细胞因子IL-8、TNF-α、MMP-9的含量，采用清淀粉样蛋白P（serum amyloid P，SAP）酶标法检测外周血CD3+、CD4+、CD8+的水平以及CD4+/CD8+的比值。 结果 治疗组急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）发生率、存活率、ICU住院时间、死亡患者存活时间均优于对照组(P＜0.05)。治疗组患者血浆中IL-8、TNF-α、MMP-9含量和CD8+显著降低，CD3+、CD4+、CD4+/CD8+明显升高，与对照组比较差异均有统计学意义(P＜0.05)。 结论 乌司他丁能够提高百草枯中毒患者的临床疗效，且效果明显，其机制可能与其抑制炎性因子的释放和调节T淋巴细胞亚群免疫功能有关。

Clinical efficacy of ulinastatin in the treatment of paraquat poisoning and its influence on inflammatory cytokines and T-lymphocyte subsets

Objective To investigate the changes of interleukin-8(IL-8), tumor necrosis factor-α(TNF-α), matrix metalloproteinase-9(MMP-9) and T-lymphocyte subsets in plasma of patients with paraquat poisoning and the effect of ulinastatin on the above indicators, in order to study the curative effect of ulinastatin on paraquat poisoning and provide a new method for the treatment of paraquat.Methods A total of 80 patients meeting the criteria of acute paraquat poisoning were selected and divided into two groups: poisoning group(n=40) and treatment group(n=40). The patients in the poisoning group received conventional treatment, while the other group received ulinastatin in addition to the basic treatment. The clinical indicators of the two groups were observed at 14 d after treatment, and the blood samples were collected at 7 d and 14 d after treatment. The levels of IL-8, TNF-α and MMP-9 in plasma were detected. The levels of CD3+, CD4+, CD8+ and the ratio of CD4+/CD8+ in peripheral blood were detected by SAP enzyme labeling method.Results The incidence of acute respiratory distress syndrome(ARDS), survival rate, duration of ICU stay and survival time of dead patients in the treatment group were better than those in the poisoning group(P＜0.05). Compared with the poisoning group, the levels of IL-8, TNF-α, MMP-9 and CD8+ in the treatment group were significantly decreased(P＜0.05), while CD3+, CD4+, and CD4+/CD8+ were significantly increased, suggesting significant difference(P＜0.05).Conclusion Ulinastatin can improve the clinical efficacy of patients wiht paraquat poisoning, and its underlying mechanism may be related to its inhibition of the release of inflammatory factors and regulation of immune function of T-lymphocyte subsets, with obvious effect. Therefore, it is worthy of clinical promotion.