脾多肽注射液对重度烧伤患者T淋巴细胞亚群的影响

发布时间：2018-07-09 12:09

本文选题：脾多肽 + 烧伤　；参考：《延安大学》2015年硕士论文

【摘要】：研究背景:烧伤后机体会出现不同程度的免疫功能紊乱已被大量的临床和实验资料证实。烧伤后患者免疫功能紊乱(Immune dysfunction)是导致机体严重感染、多器官功能障碍综合症(MODS)、全身炎症反应综合症(SIRS)甚至死亡的重要诱因。如何纠正患者的免疫紊乱,提高机体抵抗致病菌的能力,减少并发症,提高治愈率一直是临床工作者关注的问题。随着分子生物学的发展,制药工程技术的提高,人们开发出多种免疫调节剂用于临床治疗。近年来脾多肽注射液作为一种新型免疫调节药物,被广泛应用于恶性肿瘤、呼吸道及肺部感染、原发性和继发性细胞免疫缺陷病等,取得了很好的疗效,但关于脾多肽注射液在烧伤救治中的具体疗效却鲜有报道。目的:探讨脾多肽注射液对重度烧伤患者T淋巴细胞亚群的影响。为临床治疗重度烧伤时如何纠正机体免疫功能紊乱提供依据,从而减轻机体感染程度,降低多器官功能衰竭的发生率,减少并发症,提高救治率,缩短住院时间,减少患者痛苦。方法:选取2013年3月至2014年11月延安大学附属医院烧伤整形手外科收治的52例(其中2例患者放弃治疗、1例出现不良反应,被剔除)重度烧伤患者,经患者知情同意分成2组。治疗组在入院后第2天起,接受脾多肽注射液治疗,在500 ml 0.9%氯化钠注射液中加入10 ml脾多肽注射液,静脉滴注,每日1次,疗程14 d;对照组不给予脾多肽注射液治疗,其余常规治疗(包括补液、抗感染、对症支持治疗、创面处理等)两组相同。分别于治疗前与治疗后第7、14、2l天抽取患者外周静脉血,采用流式细胞仪检测两组患者T淋巴细胞总数(CD3+)及T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)数作为观察指标;分别于治疗后第7、14、21天对两组患者进行血液细菌培养及创面分泌物细菌培养,记录阳性人数;观察和记录病程中并发相关系统感染的人数。1.两组患者外周静脉血T淋巴细胞亚群比较:两组患者在治疗前及治疗后7天、14、21天外周血T淋巴细胞总数(CD3+),差异均无统计学意义(P0.05)。两组患者在治疗前CD4+细胞数比较,差异无统计学意义(P0.05);治疗后第7天、14天、21天两组患者CD4+细胞数比较,差异均有统计学意义(P0.05),治疗组CD4+细胞数高于对照组。两组患者在治疗前及治疗后第7天CD8+细胞数比较,差异均无统计学意义(P0.05);治疗后第14天、21天两组患者CD8+细胞数比较,差异均有统计学意义(P0.05),治疗组CD8+低于于对照组。两组患者在治疗前CD4+/CD8+比值比较,差异无统计学意义(P0.05);治疗后第7天、14天、21天CD4+/CD8+比值比较,差异均有统计学意义(P0.05),治疗组CD4+/CD8+比值高于对照组。2.两组患者相关感染情况比较:入院时,两组患者都没有相关感染的表现;整个研究过程中,两组患者血培养均为阴性,也没有呼吸系统的感染发生。治疗后第14、21天,治疗组创面细菌培养阳性人数明显少于对照组,两组患者于治疗后14天创面细菌培养阳性率分别是:治疗组:8%,对照组:20.8%;治疗后21天创面细菌培养阳性率分别是:治疗组:0%,对照组:8.3%;整个研究过程中,治疗组留置导尿的患者12例,对照组留置导尿的患者11例,治疗后第14天,两组留置导尿的患者中,出现泌尿系统感染的几率分别为0%和18.2%。结果:结论:脾多肽注射液作为免疫调节剂,对机体免疫功能具有调节作用,能够纠正重度烧伤引起的机体T淋巴细胞亚群失衡,加强机体抵抗力,减少并发症,提高救治率。
[Abstract]:Background: a large number of clinical and experimental data have been confirmed by various levels of immune dysfunction after burns. The immune dysfunction (Immune dysfunction) after burn is an important cause of severe infection of the body, multiple organ dysfunction syndrome (MODS), systemic inflammatory response syndrome (SIRS) and even death. It is a problem for clinical workers to correct the immune disorder of the patients, improve the body's ability to resist pathogenic bacteria, reduce the complications and improve the cure rate. With the development of molecular biology and the improvement of pharmaceutical engineering technology, many kinds of immunomodulators have been developed for clinical treatment. In recent years, Lienal Polypeptide Injection has been a new type of exemption. Pestilence drugs have been widely used in malignant tumor, respiratory and pulmonary infection, primary and secondary cell immunodeficiency diseases, and so on. The effect of Lienal Polypeptide Injection in the treatment of burn is rarely reported. Objective: To explore the effect of Lienal Polypeptide Injection on T lymphocyte subsets in severe burn patients. It provides a basis for correcting the immune function disorder in the clinical treatment of severe burns, thus reducing the degree of infection, reducing the incidence of multiple organ failure, reducing complications, improving the cure rate, shortening the time of hospitalization and reducing the pain of the patients. Methods: to select the burn and plastic hands of Affiliated Hospital of Yan'an University from March 2013 to November 2014. 52 cases of surgical treatment (2 of them gave up treatment, 1 cases had adverse reactions, were eliminated) and were divided into 2 groups by informed consent. The treatment group received Lienal Polypeptide Injection treatment for second days after admission, 10 ml Lienal Polypeptide Injection in 500 ml 0.9%, intravenous drip, 1 times a day, 14 d course of treatment; The control group was not treated with Lienal Polypeptide Injection, and the rest of the conventional treatment (including rehydration, anti infection, symptomatic support treatment, wound treatment, etc.) were the same in the two groups. The peripheral venous blood was extracted from the patients before and after the treatment on day 7,14,2l, and the total number of T lymphocytes (CD3+) and T lymphocyte subgroup (CD4+, CD8) were detected by flow cytometry. The number of +, CD4+/CD8+) was used as the observation index; the blood bacteria culture and the bacterial culture of the wound exudates were recorded on the two groups of patients on the 7,14,21 day after treatment, and the positive number was recorded. The number of T drenching subgroups in the peripheral venous blood of the group of.1. two patients was observed and recorded in the course of the disease, and the two groups were treated before and treated. 7 days after treatment, the total number of T lymphocytes in peripheral blood (CD3+) in 14,21 days was not statistically significant (P0.05). There was no significant difference in the number of CD4+ cells in the two groups before treatment (P0.05), and the number of CD4+ cells in the two groups after seventh days, 14 days and 21 days after treatment was statistically significant (P0.05), and the number of CD4+ cells in the treatment group was higher than that of the control group. There was no significant difference in the number of CD8+ cells between the two groups before and seventh days after treatment (P0.05), and the number of CD8+ cells in two groups of two groups after treatment was statistically significant (P0.05), and the CD8+ in the treatment group was lower than that in the control group. There was no statistical difference between the two groups before the treatment (P0.05). Seventh days after treatment, 14 days, 21 days CD4+/CD8+ ratio, the difference was statistically significant (P0.05), CD4+/CD8+ ratio in the treatment group was higher than the control group.2. two patients related infection situation: at admission, the two groups of patients had no related infection performance; the whole study process, the two groups of blood culture were negative, nor respiratory system. Infection occurred. On day 14,21 after treatment, the number of positive bacteria culture in the treatment group was significantly less than that of the control group. The positive rate of bacterial culture in the two groups was 8%, the control group was 20.8% after 14 days after treatment, and the positive rate of bacterial culture in the 21 day after treatment was: the treatment group: 0%, the control group: 8.3%; the whole treatment process, treatment, treatment, treatment, treatment, and treatment. Group 12 cases of indwelling catheterization, 11 cases of the control group with indwelling catheterization, fourteenth days after treatment, two groups of indwelling urinary catheterization, the incidence of urinary system infection was 0% and 18.2%. results: conclusion: Lienal Polypeptide Injection as an immune modulator, the immune function of the body can have a regulatory effect, can correct severe burns caused by the machine The imbalance of T lymphocyte subsets can enhance body resistance, reduce complications and improve the treatment rate.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R644

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