丙种球蛋白对脓毒症患者免疫状态及血清炎性因子的影响

目的 探讨丙种球蛋白在脓毒症患者治疗中的应用价值。 方法 将宁波市医疗中心李惠利东部医院收治的118例脓毒症患者采用随机数字法分为2组,每组59例。对照组给予基础治疗,观察组加用丙种球蛋白治疗。比较2组治疗前后临床指标(SOFA评分、APACHE-Ⅱ评分、WBC、HR)、T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)、免疫球蛋白(IgG、IgM、IgA)及血清炎性因子(CRP、TNF-α、IL-10)水平的变化。 结果 治疗后与对照组比较,观察组SOFA评分[(6.72±1.25)分]、APACHEⅡ评分[(11.19±2.09)分]、WBC[(7.82±1.32)×109/L]及HR[(83.29±15.35)次/min]均明显降低(均P<0.001)。治疗后,观察组T淋巴细胞亚群水平(CD4+、CD8+及CD4+/CD8+)显著改善(均P<0.05),且改善效果明显优于对照组(均P<0.05);对照组除CD8+无显著变化外,CD4+、CD4+/CD8+均明显改善(均P<0.05)。治疗后,观察组IgG水平明显升高(P<0.05),且高于对照组(P<0.05);对照组体液免疫无明显变化(均P>0.05)。治疗后,2组促炎因子(CRP、TNF-α)水平显著降低(均P<0.05),且观察组明显低于对照组(均P<0.05);2组抑炎因子(IL-10)水平显著升高(均P<0.05),且观察组明显高于对照组(P<0.05)。 结论 丙种球蛋白治疗可明显增强脓毒症患者细胞免疫及体液免疫状态,改善患者血清炎性因子水平,有助于患者病情的改善。 

Effect of gamma globulin on immune status and serum inflammatory factors in patients with sepsis

Objective To investigate the application value of gamma globulin in the treatment of sepsis. Methods A total of 118 cases of sepsis patients in our hospital were randomly divided into two groups, 59 cases each group. The control group was received basic treatment, and the observation group was treated with gamma globulin on the basis of the control group. The changes in clinical indicators(SOFA score, APACHE Ⅱ score, WBC, HR), T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+), immunoglobulin(IgG, IgM, IgA) and serum inflammatory factors(CRP, TNF-α, IL-10) were compared between the two groups before and after treatment. Results Compared with the control group after treatment, the SOFA score(6.72±1.25), APACHE Ⅱ score(11.19±2.09), WBC(7.82±1.32) and HR(83.29±15.35) in the observation group were significantly reduced(all P<0.001). After treatment, the level of T lymphocyte subsets(CD4+, CD8+ and CD4+/CD8+) in the observation group was significantly improved(all P<0.05), and the improvement effect was significantly better than that in the control group(all P<0.05). Meanwhile, in the control group, CD4+ and CD4+/CD8+ were significantly improved(all P<0.05). IgG levels in the observation group were significantly increased(P<0.05) and significantly higher than those in the control group(P<0.05). There was no significant change in humoral immunity in the control group(all P>0.05). After treatment, the levels of pro-inflammatory factors(CRP, TNF-α) in the two groups were significantly decreased, and those in the observation group were lower than those in the control group(P<0.05). The level of anti-inflammatory factor IL-10 in the two groups significantly increased(all P<0.05), and that in the observation group was significantly higher than that in the control group(all P<0.05). Conclusion Gamma globulin adjuvant therapy can significantly enhance the cellular immunity and humoral immunity of patients with sepsis, improve the level of serum inflammatory factors, and contribute to the improvement of patients' condition.