早期應用小劑量糖皮質激素對膿毒癥休克患者T淋巴細胞亞群的影響

喻秋平　楊蕙文　葉興文　趙鑫

【摘要】 目的：探討膿毒癥休克患者早期應用小劑量糖皮質激素，對其炎性指標和T淋巴細胞亞群的影響。方法：將125例確診膿毒癥休克患者按照隨機數字表法分為激素組65例和非激素組60例。激素組在綜合治療基礎上給予氫化可的松100 mg/bid，靜脈滴注給藥，療程7 d。抽取靜脈血檢測二組入院時及入院第7天血清降鈣素原、腫瘤壞死因子、白介素-6等炎性指標以及淋巴細胞亞群CD3+、CD4+、CD8+、CD4+/CD8+水平，同時記錄治療前后二組急性生理學與慢性健康狀況（APACHE Ⅱ）評分。結果：兩組治療后降鈣素原、腫瘤壞死因子、白介素-6水平均較治療前降低，治療后激素組各指標均低于非激素組，差異均有統計學意義（P<0.01）。治療后兩組CD3+、CD4+、CD4+/CD8+均較治療前明顯升高，差異均有統計學意義（P<0.05）；治療后激素組CD3+、CD4+、CD4+/CD8+均較非激素組升高更明顯，差異均有統計學意義（P<0.01）。兩組治療后APACHE Ⅱ評分均較治療前降低，治療后激素組APACHE Ⅱ評分低于非激素組，差異均有統計學意義（P<0.01）。結論：膿毒癥休克患者早期應用小劑量糖皮質激素，可以抑制全身炎癥反應，改善患者免疫功能，可能對臨床治療有所幫助。

【關鍵詞】 糖皮質激素； 膿毒癥休克； T淋巴細胞亞群

Effect of Early Application of Low-dose Glucocorticoid on T Lymphocyte Subsets in Patients with Septic Shock/YU Qiu-ping，YANG Hui-wen，YE Xing-wen，et al.//Medical Innovation of China，2017，14（22）：006-009

【Abstract】 Objective：To investigate the effect of early application of low-dose glucocorticoid on the inflammatory index and T lymphocyte subsets in patients with septic shock.Method：A total of 125 patients with severe sepsis were divided into hormone group of 65 cases and non-hormone group of 60 cases according to random number table method.Hormone group on the basis of comprehensive treatment was given hydrocortisone 100 mg/bid，continuous intravenous infusion，continuous administration of 7 days.Blood samples of two groups were detected，inflammatory indexes such as serum procalcitonin，tumor necrosis factor （TNF-α），interleukin-6 and lymphocyte subsets CD3+，CD4+，CD8+，CD4+/CD8+ of two groups on admission and at the seventh day of admission were compared，the acute physiology and chronic health status（APACHE Ⅱ） score of two groups were recorded before and after treatment.Result：Procalcitonin，tumor necrosis factor，interleukin -6 levels of two groups after treatment were lower than before treatment，and inflammatory indexes of hormone group after treatment were lower than those of non-hormone group，the differences were statistically significant（P<0.01）.After treatment，the levels of CD3+、CD4+、CD4+/CD8+ of two groups were significantly higher than before treatment（P<0.05）.After treatment，the levels of CD3+、CD4+、CD4+/CD8+ of hormone group was more significant than those of non-hormone group（P<0.01）.The APACHE Ⅱ scores of two groups after treatment were lower than before treatment，the APACHE Ⅱ scores of hormone group after treatment was lower than that of non-hormone group，the differences were statistically significant（P<0.01）.Conclusion：Early application of low-dose glucocorticoid in patients with sepsis shock can inhibit systemic inflammatory response，improve immune function，it may be helpful to clinical treatment.endprint

【Key words】 Glucocorticoid； Septic shock； T lymphocyte subsets

First-authors address：The Affiliated Hospital of Jiujiang College，Jiujiang 332000，China

doi：10.3969/j.issn.1674-4985.2017.22.002

膿毒癥休克是指由膿毒癥引起，雖經充分液體復蘇后仍無法逆轉持續低血壓[1]。目前已經證實膿毒癥的主要發病機制是過度的全身炎癥反應與機體免疫功能紊亂[2]。糖皮質激素具有穩定細胞膜，保護內皮細胞功能的作用，在治療膿毒癥全身炎癥反應過程中起著重要的作用[3]。因此，本研究擬通過對膿毒癥休克患者早期應用小劑量糖皮質激素，探討其對炎癥反應指標和免疫功能指標的影響，現報道如下。

1 資料與方法

1.1 一般資料 嚴格按照中國嚴重膿毒癥/膿毒性休克治療指南（2014）提出的診斷標準，篩選符合標準的本院重癥醫學科2015年1月-2016年12月收治的125例膿毒癥休克患者，其中包括肺部感染78例，急性腹腔感染36例，泌尿系感染6例，軟組織感染及顱內感染5例。……