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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2021年03期

页码:

301-304

栏目:

论著

出版日期:

2021-06-20

文章信息/Info

Title:

Effect of thymosin α1 immunotherapy combined with anti-infection on the prognosis of severe pneumonia and possible therapeutic mechanism

作者:

严锡祥¹; 郑爱东¹; 张振恩¹; 潘国翠¹; 崔永华²

224700 江苏,南通大学附属建湖医院重症医学科¹、神经外科²

Author(s):

Yan Xixiang¹;  Zheng Aidong¹;  Zhang Zhenen¹;  Pan Guocui¹;  Cui Yonghua².

¹Department of critical medicine; ²Department neurosurgery, Jianhu Hospital Affiliated to Nantong University, Yancheng 224700, China

关键词:

胸腺肽α1;  免疫治疗;  重症肺感染;  临床疗效

Keywords:

Thymosin α1;  Immunotherapy;  Severe pneumonia;  Clinical efficacy;  Mechanisms

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2021.03.008

摘要:

目的 探讨胸腺肽α1(Tα1)联合抗感染治疗对重症肺炎转归的影响,并分析其发挥作用的可能机制。方法 重症肺感染患者71例,随机分为治疗组38例,对照组33例。对照组予以常规抗感染及对症支持治疗,治疗组在对照组的基础上联合皮下注Tα1 11.6 mg 1次/每天,连续7 d,1周后改为2次/周。Tα1治疗前后测定外周血T细胞亚群和自然杀伤(NK)细胞,酶联免疫吸附法测定炎症因子如TNF-α、IL-10等水平,并比较两组患者的抗生素使用时间、住院时间及病死率。结果 两组患者在性别、年龄、心率、呼吸频率、动脉血氧分压(PaO₂)、氧合指数(PaO₂/FiO₂)、收缩压、痰培养阳性无明显差异(P>0.05),具有可比性。治疗组患者死亡6例,病死率为15.78%; 对照组患者死亡7例,病死率为21.21%,较治疗组明显增加(P<0.05)。治疗组抗生素应用时间及住院天数明显较对照组缩短[分别为(12.95±1.94)vs.(15.98±2.01)d,(15.73±2.13)vs.(18.74±3.60)d](P<0.05)。治疗前,两组患者的CD3、CD4、CD8、CD4/CD8、NK细胞数无明显差异; 治疗后,两组患者的CD3、CD4、CD8、NK细胞数明显增加,且治疗组患者CD3、CD4、CD8、NK细胞数[分别为(48.57±7.21)%、(32.83±4.20)%、(24.89±3.05)%、(20.01±2.96)%]较对照组[分别为(45.89±6.72)%、(29.04±3.16)%、(21.53±2.56)%、(16.72±2.03)%]明显增加(P<0.05)。治疗前,两组患者的TNF-α、IL-10水平无明显差异。治疗后,两组患者TNF-α水平均较治疗前明显降低,而且治疗组TNF-α水平明显较对照组低[(17.95±2.28)vs.(20.79±3.02)](P<0.05)。治疗后,两组患者IL-10水平均较治疗前明显升高,而且治疗组IL-10水平明显较对照组高[(12.82±1.12)vs.(9.79±1.02)](P<0.05)。结论 重症肺炎患者存在免疫细胞功能紊乱,Tα1免疫治疗能够很好地调节免疫细胞功能、减轻体内炎症反应,增强抗感染治疗效果。

Abstract:

Objective To study the effects of thymosin α1 combined with anti-infective therapy on the prognosis of severe pneumonia and analyze its possible mechanism. Methods 71 patients with severe pulmonary infection were randomly divided into treatment group(38 cases)and control group(33 cases). The control group was given routine anti-infection and symptomatic support treatment. On the basis of routine anti-infection and symptomatic support treatment, the treatment group were given thymosin α1 1.6 mg subcutaneously once a day for 7 consecutive days and then changed to twice a week. T lymphocyte subsets and NK cells in peripheral blood were measured before and after treatment with thymosin α1. Inflammatory factors tumor necrosis factor alpha and interleukin 10 were measured by enzyme-linked immunosorbent assay(ELISA). Moreover, compared the antibiotic use time, hospitalization time and mortality between groups. Results There were no significant differences in gender, age, heart rate, respiratory rate, PaO₂, PaO₂/FiO₂, systolic blood pressure and positive sputum culture between the two groups(P>0.05). The mortality rate was 15.78% with 6 patients died in the treatment group, and the mortality rate of the control group was 21.21% with 7 cases died, and the difference was significantly(P<0.05). The antibiotic application time and hospitalization days in the treatment group were significantly shorter than those in the control group [12.95±1.94)vs.(15.98±2.01)d,(15.73±2.13)vs.(18.74±3.60)d, respectively](P<0.05). Before treatment, the number of CD3, CD4, CD8, CD4/CD8 and NK cells in the two groups had no significant difference; after treatment, the number of CD3, CD4, CD8 and NK cells in the two groups increased significantly; the number of CD3, CD4, CD8 and NK cells in the treatment group [(48.57±7.21)%,(32.83±4.20)%,(24.89±3.05)%,(20.01±2.96)%] were higher than those in the control group[45.89±6.72)%,(29.04±3.16)%,(21.53±2.56)%,(16.72±2.03)%](P<0.05). Before treatment, there was no significant difference in the levels of TNF-α and IL-10 between the two groups. After treatment, the levels of TNF-α in both groups were significantly lower, and the levels of TNF-α in the treatment group were significantly lower than those in the control group [(17.95±2.28)vs.(20.79±3.02)](P<0.05). After treatment, the levels of IL-10 in both groups were significantly higher than those before treatment, and the levels of IL-10 in the treatment group were significantly higher than those in the control group [(12.82±1.12)vs.(9.79±1.02)](P<0.05). Conclusions Immunocyte dysfunction exists in severe pneumonia patients. Thymosin α1 immunotherapy may well regulate the function of immune cells, alleviate inflammation in vivo, and enhance the anti-infective effect.

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备注/Memo

备注/Memo:

基金项目: 江苏省333工程科研基金(BRA201719)

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更新日期/Last Update: 2021-06-20