乌司他丁对婴幼儿重症肺炎外周血APC、IL-1R1表达的影响
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摘要
目的:探讨乌司他丁联合常规治疗治疗对婴幼儿重症肺炎外周血APC、IL-1R1表达的影响。方法:选取2014年2月至2016年2月来四川省仁寿县人民医院进行治疗重症肺炎患儿120例,按照随机数字表法将其分为试验组和对照组。给予对照组患儿常规治疗,在常规治疗的基础上给予试验组患儿乌司他丁治疗。比较1个疗程后两组患儿的治疗有效率;对比两组患儿治疗前后免疫球蛋白水平;检测两组患儿治疗不同时间点外周血活化蛋白C(activated protein C,APC)和IL-1R1水平。结果:1个疗程后试验组患儿的治疗有效率显著高于对照组患儿(93.33%vs 76.67%,P<0.05)。治疗前两组患儿3种免疫球蛋白水平没有显著差异(P>0.05)1个疗程后对照组患儿IgA和IgM没有显著变化(P<0.05),但试验组患儿Ig G水平显著上升[(8.94±1.51 g·L~(-1))vs(12.15±0.92 g·L~(-1)),P<0.05]。治疗前患儿体内炎性因子水平没有显著差异(P>0.05);治疗3 d和5 d,试验组患儿APC水平更高且IL-1R1水平更低。结论:因乌司他丁可以有效缓解婴幼儿重症肺炎病情,调节患儿免疫系统功能,缓解炎性反应,值得临床推广。
Objective: To explore the effects of ulinastatin combined with conventional therapy on APC and IL-1R1 expression in peripheral blood of pediatric patients with severe pneumonia. Methods: One hundred and twenty children with severe pneumonia coming to our hospital from February 2014 to February 2016 were selected. According to the random number table method, they were divided into two groups, the experimental group and the control group. In the control group, children were treated with conventional regimen. The patients in the experimental group were treated with ulinastatin on the basis of routine treatment. The efficacies of the two groups after a course of treatment were compared. The levels of immunoglobulin were compared between the two groups before and after the treatment. The levels of activated protein C(APC) and IL-1R1 in peripheral blood were measured at different time points. Results: The effective rate of treatment in the experimental group was significantly higher than that in the control group(99.33% vs 76.67%, P<0.05). There were no significant differences in the levels of three kinds of immunoglobulins between the two groups before treatment(P >0.05). There was no significant change in IGA and IGM levels in the control group after a course of treatment(P <0.05). The level of Ig G in the experimental group was significantly increased after a course of treatment [(8.94±1.51 g·L~(-1)) vs(12.15±0.92 g·L~(-1)), P <0.05]. There was no significant difference in the levels of inflammatory cytokines between the two groups before treatment(P>0.05). At 3 and 5 days after treatment, the APC level was higher in the experimental group and the IL-1R1 level was lower. Conclusion: Ulinastatin treatment can effectively alleviate the condition of children with severe pneumonia, regulate the immune system function and relieve inflammatory response. It is worthy of clinical promotion.
Objective: To explore the effects of ulinastatin combined with conventional therapy on APC and IL-1R1 expression in peripheral blood of pediatric patients with severe pneumonia. Methods: One hundred and twenty children with severe pneumonia coming to our hospital from February 2014 to February 2016 were selected. According to the random number table method, they were divided into two groups, the experimental group and the control group. In the control group, children were treated with conventional regimen. The patients in the experimental group were treated with ulinastatin on the basis of routine treatment. The efficacies of the two groups after a course of treatment were compared. The levels of immunoglobulin were compared between the two groups before and after the treatment. The levels of activated protein C(APC) and IL-1R1 in peripheral blood were measured at different time points. Results: The effective rate of treatment in the experimental group was significantly higher than that in the control group(99.33% vs 76.67%, P<0.05). There were no significant differences in the levels of three kinds of immunoglobulins between the two groups before treatment(P >0.05). There was no significant change in IGA and IGM levels in the control group after a course of treatment(P <0.05). The level of Ig G in the experimental group was significantly increased after a course of treatment [(8.94±1.51 g·L~(-1)) vs(12.15±0.92 g·L~(-1)), P <0.05]. There was no significant difference in the levels of inflammatory cytokines between the two groups before treatment(P>0.05). At 3 and 5 days after treatment, the APC level was higher in the experimental group and the IL-1R1 level was lower. Conclusion: Ulinastatin treatment can effectively alleviate the condition of children with severe pneumonia, regulate the immune system function and relieve inflammatory response. It is worthy of clinical promotion.
引文
[1]Xiao X,Xue L,Sheng H L,et al.Correlation between serum levels of C-reactive protein and infant pneumonia:A meta-analysis[J].Exp Ther Med,2015,9(6):2331-2338.
[2]Fox M P,Thea D M,Sadruddin S,et al.Low rates of treatment failure in children aged 2-59 months treated for severe pneumonia:a multisite pooled analysis[J].Clin Infect Dis,2013,56(7):978-987.
[3]Cohen M J,Call M,Nelson M,et al.Critical role of activated protein C in early coagulopathy and later organ failure,infection and death in trauma patients[J].Ann Surg,2012,255(2):379-385.
[4]Song C,He L,Zhang J,et al.Fluorofenidone attenuates pulmonary inflammation and fibrosis via inhibiting the activation of NALP3inflammasome and IL-1β/IL-1R1/My D88/NF-κB pathway[J].JCell Mol Med,2016,20(11):2064-2077.
[5]王旨,吴寒冰.乌司他丁对重症肺炎患者肺表面活性蛋白及抗炎、促炎介质的影响[J].中国生化药物杂志,2016,36(3):43-45.
[6]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7]朱凯,张文俊,宋显相,等.多巴胺辅助治疗婴幼儿重症肺炎疗效观察[J].中国医刊,2014,49(3):84-85.
[8]王永明.婴幼儿肺炎并发心功能不全临床特点回顾性分析[J].中国实用医药,2016,11(26):143-144.
[9]曾庆玲,唐培佳,徐月秀,等.乌司他丁在婴幼儿体外循环时的抗炎和肺功能的保护作用[J].中国循环杂志,2014,29(10):819-822.
[10]Karnad D R,Bhadade R,Verma P K,et al.Intravenous administration of ulinastatin(human urinary trypsin inhibitor)in severe sepsis:a multicenter randomized controlled study[J].Intensive Care Med,2014,40(6):830-838.
[11]周从阳,谢姝,罗雅娟,等.百草枯中毒大鼠肺组织中的4-羟基壬烯醛表达和乌司他丁的影响[J].中华劳动卫生职业病杂志,2012,30(6):457-459.
[12]Hou J,Zhu M W,He X W,et al.Effect of hyperbaric oxygen and ulinastatin on plasma endotoxin,soluble CD14,endotoxinn e u t r a l i z i n g c a p a c i t y a n d c y t o k i n e s i n a c u t e n e c r o t i z i n g pancreatitis[J].Can J Surg,2010,53(4):241-245.
[13]宋成.氟非尼酮抑制NALP3/IL-1R1/My D88通路减轻BLM诱导的小鼠肺炎症及纤维化[D].长沙:中南大学,2014.
[14]任蓉蓉,任晓楠,秦波音,等.白细胞介素-1受体1在H1N1流感病毒感染中发挥促炎症病理应答作用[J].中华微生物学和免疫学杂志,2016,36(12):887-893.
[15]王鹿,蔡海峰,胡万宁,等.白细胞介素1受体辅助蛋白在疾病中的作用研究进展[J].中国综合临床,2014,30(4):439-441.
[16]杨家清,孔祥林,杨福海,等.乌司他丁佐治成人重症肺炎并对炎性因子与细胞免疫功能的影响[J].临床肺科杂志,2015,20(11):2076-2079.
[17]周建明,胡若愚,靖胜杰,等.活化蛋白C对体外循环大鼠肺的保护作用[J].东南大学学报(医学版),2014,33(6):756-760.
[2]Fox M P,Thea D M,Sadruddin S,et al.Low rates of treatment failure in children aged 2-59 months treated for severe pneumonia:a multisite pooled analysis[J].Clin Infect Dis,2013,56(7):978-987.
[3]Cohen M J,Call M,Nelson M,et al.Critical role of activated protein C in early coagulopathy and later organ failure,infection and death in trauma patients[J].Ann Surg,2012,255(2):379-385.
[4]Song C,He L,Zhang J,et al.Fluorofenidone attenuates pulmonary inflammation and fibrosis via inhibiting the activation of NALP3inflammasome and IL-1β/IL-1R1/My D88/NF-κB pathway[J].JCell Mol Med,2016,20(11):2064-2077.
[5]王旨,吴寒冰.乌司他丁对重症肺炎患者肺表面活性蛋白及抗炎、促炎介质的影响[J].中国生化药物杂志,2016,36(3):43-45.
[6]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7]朱凯,张文俊,宋显相,等.多巴胺辅助治疗婴幼儿重症肺炎疗效观察[J].中国医刊,2014,49(3):84-85.
[8]王永明.婴幼儿肺炎并发心功能不全临床特点回顾性分析[J].中国实用医药,2016,11(26):143-144.
[9]曾庆玲,唐培佳,徐月秀,等.乌司他丁在婴幼儿体外循环时的抗炎和肺功能的保护作用[J].中国循环杂志,2014,29(10):819-822.
[10]Karnad D R,Bhadade R,Verma P K,et al.Intravenous administration of ulinastatin(human urinary trypsin inhibitor)in severe sepsis:a multicenter randomized controlled study[J].Intensive Care Med,2014,40(6):830-838.
[11]周从阳,谢姝,罗雅娟,等.百草枯中毒大鼠肺组织中的4-羟基壬烯醛表达和乌司他丁的影响[J].中华劳动卫生职业病杂志,2012,30(6):457-459.
[12]Hou J,Zhu M W,He X W,et al.Effect of hyperbaric oxygen and ulinastatin on plasma endotoxin,soluble CD14,endotoxinn e u t r a l i z i n g c a p a c i t y a n d c y t o k i n e s i n a c u t e n e c r o t i z i n g pancreatitis[J].Can J Surg,2010,53(4):241-245.
[13]宋成.氟非尼酮抑制NALP3/IL-1R1/My D88通路减轻BLM诱导的小鼠肺炎症及纤维化[D].长沙:中南大学,2014.
[14]任蓉蓉,任晓楠,秦波音,等.白细胞介素-1受体1在H1N1流感病毒感染中发挥促炎症病理应答作用[J].中华微生物学和免疫学杂志,2016,36(12):887-893.
[15]王鹿,蔡海峰,胡万宁,等.白细胞介素1受体辅助蛋白在疾病中的作用研究进展[J].中国综合临床,2014,30(4):439-441.
[16]杨家清,孔祥林,杨福海,等.乌司他丁佐治成人重症肺炎并对炎性因子与细胞免疫功能的影响[J].临床肺科杂志,2015,20(11):2076-2079.
[17]周建明,胡若愚,靖胜杰,等.活化蛋白C对体外循环大鼠肺的保护作用[J].东南大学学报(医学版),2014,33(6):756-760.