乌司他丁对急性肺损伤患者的免疫调节作用

摘要

Objective:To evaluate immunomodulatory effect of ulinastatin in patients with acute lung injury (ALI) .Methods:Thirty patients ,who accorded with diagnostic criteria of ALI ,were randomly assigned to the control group (14 cases) or the treatment group (16 cases) .The patients in the control group were treated with regular therapy ,while those in the treatment group received 7 days’ treatment with ulinastatin in addition .The acute physiology and chronic health evaluation(APACHE)Ⅱscore was evaluated for the patients in two groups before and after the treatment ,while the oxygenation index was calculated . The concentrations of tumor necrosis factor alpha (TNF‐α) and interleukin‐6 ,8 ,10 (IL‐6 ,8 ,10) were determined by enzyme‐linked immunosorbent assay and the percentages of peripheral blood T lymphocyte subsets (CD3+ 、CD4+ 、CD8+ ) was detected by flow cytometry .The immune globulin (IgA ,IgG ,IgE ,IgM )was detected .The length of ICU stay and mortality were coun‐ted .Results:After the treatment ,the APACHEⅡ score and Oxygenation index in the treatment group were much lower than those in the control group .The expression of peripheral blood T lymphocyte subsets(CD3+ 、CD4+ 、CD8+ ) in the treatment af‐ter the treatment was much higher than that before the treatment .The levels of TNF‐αand IL‐6 ,8 ,10 in the treatment group were significantly lower than those in the control group .The length of ICU stay decreased and the difference was statistically significant(P<0 .05) .However ,no significant difference was found in the immune globulin IgA ,IgG ,IgE ,IgM and the mor‐tality (P>0 .05) .Conclusions:Ulinastatin ,in a certain extent ,improves the immune function of patients with ALI ,especially for cellular immune enhancement .%目的：评价乌司他丁对急性肺损伤（ALI）患者的免疫调节作用。方法：将符合ALI诊断标准的30例患者随机分成对照组（14例）和治疗组（16例）。对照组给予常规治疗，治疗组在常规治疗的基础上加用乌司他丁，疗程为7 d。两组患者治疗前后进行急性病生理学和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，计算氧合指数；采用酶联免疫吸附法检测血清肿瘤坏死因子（tumor necrosis factor‐α，TNF‐α）与白细胞介素‐6（interleukin‐6，IL‐6）、IL‐8、IL‐10水平；采用流式细胞术检测外周血T淋巴细胞亚群百分比（CD3＋、CD4＋、CD8＋）；检测免疫球蛋白IgA、IgG、IgE、IgM。统计患者住重症监护病房（ICU ）时间及病死率。结果：与对照组比较，治疗组治疗后APACHEⅡ评分下降更明显，氧合指数增加更明显；与治疗前相比，治疗组治疗后CD3＋表达明显上升，CD8＋下降；治疗组血清T N F‐α、IL‐6、IL‐8水平较对照组显著下降，IL‐10水平升高；治疗组患者住IC U时间减少，差异有统计学意义（P＜0．05）。两组患者的免疫球蛋白IgA、IgG、IgE、IgM 水平及病死率差异无统计学意义（P＞0．05）。结论：乌司他丁可在一定程度上改善ALI患者的免疫机能，尤其能增强细胞免疫。