Effect of thymosin α 1 on T lymphocytes and TLR9 signaling pathway in patients with sepsis
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摘要:
目的 通过观察胸腺肽α1治疗脓毒症患者免疫等指标的变化,为其治疗脓毒症提供依据。 方法 选取2017年1月—2020年8月期间安徽中医药大学第一附属医院ICU收治的50例脓毒症患者,按照随机数字表法分为对照组和观察组,各25例。对照组给予抗感染、改善脏器功能等常规综合治疗,观察组在对照组治疗的基础上加用胸腺肽α1治疗,疗程为7 d。分别观察2组患者治疗前后CD3+、CD8+、CD4+/CD8+比值等T细胞指标;降钙素原(PCT)、C反应蛋白(CRP)水平和TLR9信号通路中Toll样受体9(TLR9)、核因子KB(NF-κB)蛋白表达等炎症指标;序贯器官功能衰竭评估(SOFA)和急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分等病情严重程度指标。 结果 观察组治疗后CD3+上升、CD8+下降、CD4+/CD8+比值上升,与对照组治疗后相比,差异有统计学意义(t=4.874、3.864、2.162,均P < 0.05)。观察组治疗后,患者PCT、CRP水平和TLR9、NF-κB蛋白表达水平明显低于对照组(t=4.833、7.081、5.871、8.361,均P < 0.05)。观察组治疗后SOFA和APACHEⅡ评分均下降,下降程度明显低于对照组(t=3.672、5.354,均P < 0.05)。 结论 胸腺肽α1可很好地调节脓毒症患者的免疫功能,减轻脓毒症的炎症反应。 Abstract:Objective To observe the effects of thymosin α1 on changes in indicators such as immunity in patients with sepsis, and to seek evidence-based evidence for its application in the treatment of sepsis. Methods According to the random number table, 50 patients with sepsis admitted to the ICU of the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2017 to August 2020 were divided into control group and observation group with 25 cases in each group. Patients in the control group were given conventional comprehensive treatments such as anti-infection, improvement of organ function for 7 days. Patients in the observation group were treated with thymosin α1 on the basis of the conventional comprehensive treatments for 7 days. The T cell indicators such as the T cell subsets CD3+, CD8+, CD4+/CD8+ ratio before and after treatment in the two groups, inflammation indicators procalcitonin(PCT), C reactive protein(CRP) levels and TLR9, NF-κB protein expression in the TLR9 signaling pathway, disease severity indicators sequential organ failure assessment (SOFA) score and acute Physiology and chronic health evaluation (APACHE Ⅱ) score were observed. Results After treatment in the observation group, CD3+ increased, CD8+ decreased, and CD4+/CD8+ ratio increased. Compared with the control group, the difference was statistically significant (t=4.874, 3.864, 2.162, all P < 0.05). Compared with the control group, the inflammatory index PCT, CRP levels and the TLR9 and NF-KB protein expression levels in the observation group were significantly lower than those in the control group (t=4.833, 7.081, 5.871, 8.361, all P < 0.05). The disease severity indicators SOFA score and APACHE Ⅱ score decreased significantly. The SOFA score and APACHE Ⅱ score of the observation group decreased after treatment, and the degree of decline was significantly lower than that of the control group (t=3.672, 5.354, all P < 0.05). Conclusion Thymosin α1 can well regulate the immune function of patients with sepsis and reduce the inflammatory response of sepsis. -
Key words:
- Thymosin α1 /
- Sepsis /
- T cell subsets /
- TLR9 /
- Immune function
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表 1 2组脓毒症患者临床基线资料比较
组别 例数 性别(男/女,例) 年龄(x±s,岁) 原发感染部位(例) 肺部 腹腔 泌尿系统 其他 观察组 25 15/10 61.2±17.1 20 3 1 1 对照组 25 13/12 60.7±16.9 19 4 1 1 统计量 0.328a 0.104b 0.168a P值 0.569 0.918 0.983 注:a为χ2值,b为t值。 表 2 2组脓毒症患者治疗前后T细胞亚群比较(x±s)
组别 例数 CD3+(%) CD8+(%) CD4+/CD8+ 治疗前 治疗1周后 治疗前 治疗1周后 治疗前 治疗1周后 观察组 25 50.36±9.19 59.81±9.89a 26.71±4.21 21.03±3.92a 1.16±0.38 1.67±0.49a 对照组 25 50.49±9.25 49.98±8.91 26.82±4.53 25.96±4.18 1.15±0.36 1.17±0.39a t值 0.561 4.874 0.173 3.864 0.121 2.162 P值 0.732 0.023 0.622 0.013 0.713 0.001 注:与同组治疗前比较,aP<0.05。 表 3 2组脓毒症患者治疗前后炎症反应指标比较(x±s)
组别 例数 PCT/(ng/mL) CRP/(mg/L) 治疗前 治疗1周后 治疗前 治疗1周后 观察组 25 6.51±1.48 2.73±1.23a 68.02±10.16 23.92±5.97a 对照组 25 6.72±1.71 5.16±1.58a 67.68±9.98 45.93±9.29a t值 1.021 4.833 1.572 7.081 P值 0.282 0.034 0.724 < 0.001 注: 与同组治疗前比较,aP<0.05。 表 4 2组脓毒症患者治疗前后TLR9和NF-κB比较(x±s)
组别 例数 TLR9/(ng/mL) NF-κB/(pg/mL) 治疗前 治疗1周后 治疗前 治疗1周后 观察组 25 15.08±1.74 8.62±0.76a 100.36±10.89 58.63±5.97a 对照组 25 15.21±1.81 14.96±1.39 100.23±10.57 99.98±9.68 t值 1.963 5.871 2.352 8.361 P值 0.334 0.031 0.642 0.001 注:与同组治疗前比较,aP<0.05。 表 5 2组脓毒症患者治疗前后SOFA和APACHE Ⅱ评分比较(x±s)
组别 例数 SOFA评分 APACHEⅡ评分 治疗前 治疗1周后 治疗前 治疗1周后 观察组 25 10.06±2.04 4.62±0.55a 21.37±8.78 15.97±7.67a 对照组 25 10.21±2.81 8.17±2.39a 21.18±9.85 18.74±7.18a t值 1.042 3.672 2.012 5.354 P值 0.733 0.001 0.923 0.002 注:与同组治疗前比较,aP<0.05。 -
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