低分子肝素对重症肺炎患者体内细胞因子的影响
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摘要
目的:探讨低分子肝素抑制重症肺炎患者炎性反应的机制。方法:收集重症肺炎患者共49例,随机分成两组,对照组给予常规治疗,观察组在常规治疗基础上加用低分子肝素5 000 U皮下注射,1次/d,连续治疗7 d。分别在治疗开始前与治疗后第7天,监测外周血中炎性细胞因子IL-6、IL-8、IL-10、IL-17、IL-23、TNF-α的变化。结果:与对照组相比,低分子肝素治疗组在治疗第7天,IL-6、IL-8、IL-10、IL-17、IL-23、TNF-α的水平明显降低(P<0.05),并且低分子肝素组机械通气时间明显降低。结论:低分子肝素可以通过抑制炎性细胞因子的生成,改善重症肺炎患者预后。
Objective: To explore the mechanism of low molecular weight heparin( LMWH) to inhibit the inflammatory response of patients with severe pneumonia. Methods: Collected a total of 49 patients with severe pneumonia,randomly divided into two groups,control group given conventional treatment,observation group( LMWH group) on the basis of conventional treatment combined with low molecular heparin sodium 5 000 U subcutaneous injection,1 time/day,for 7 days. The changes of the inflammatory cytokines IL-6,IL-8,IL-10,IL-17,IL-23 and TNF-α levels in the serum were monitored respectively before and after treatment. Results: Compared with control group,low molecular heparin treatment group in the treatment of 7 days,IL-6,IL-8,IL-10,IL-17,IL-23,TNF-α levels significantly decreased( P < 0. 05),and low heparin group mechanical ventilation time was obviously decreased too. Conclusion: Low molecular weight heparin can improve the prognosis of patients with severe pneumonia by inhibiting the levels of inflammatory cytokines.
Objective: To explore the mechanism of low molecular weight heparin( LMWH) to inhibit the inflammatory response of patients with severe pneumonia. Methods: Collected a total of 49 patients with severe pneumonia,randomly divided into two groups,control group given conventional treatment,observation group( LMWH group) on the basis of conventional treatment combined with low molecular heparin sodium 5 000 U subcutaneous injection,1 time/day,for 7 days. The changes of the inflammatory cytokines IL-6,IL-8,IL-10,IL-17,IL-23 and TNF-α levels in the serum were monitored respectively before and after treatment. Results: Compared with control group,low molecular heparin treatment group in the treatment of 7 days,IL-6,IL-8,IL-10,IL-17,IL-23,TNF-α levels significantly decreased( P < 0. 05),and low heparin group mechanical ventilation time was obviously decreased too. Conclusion: Low molecular weight heparin can improve the prognosis of patients with severe pneumonia by inhibiting the levels of inflammatory cytokines.
引文
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[2]谭倩,刘志丹,李晓燕,等.Th17/Treg细胞失衡在变应性鼻炎中的作用研究进展[J].中国免疫学杂志,2017,33(4):638-640.Tan Q,Liu ZT,Li XY,et al.Advances in the role of Th17/Treg imbalance in allergic rhinitis[J].Chin J Immunol,2017,33(4):638-640.
[3]李程锦,陈湘平,黄浩,等.普通肝素与低分子肝素在老年重症肺炎治疗中的应用价值[J].白求恩医学杂志,2017,15(4):444-446.Li JC,Chen XP,Huang H,et al.The value of common heparin and low molecular heparin in the treatment of severe pneumonia[J].JBethune Med Sci,2017,15(4):444-446.
[4]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-79.Respiratory medicine branch of Chinese medical association.Guidelines for diagnosis and treatment of adult community-acquired pneumonia in China(2016)[J].Chin J Tuberculosis Respirat Dis,2016,39(4):253-79.
[5]Levy SD,Alladina JW,Hibbert KA,et al.High-flow oxygen therapy and other inhaled therapies in intensive care units[J].Lancet(London,England),2016,387(10030):1867-1878.
[6]Li H,Cao B.Pandemic and avian influenza a viruses in humans:epidemiology,virology,clinical characteristics,and treatment strategy[J].Clin Chest Med,2017,38(1):59-70.
[7]刘玲玲,黄媛,马迪,等.IL-17参与巨细胞病毒肝炎致病机制的研究[J].中国免疫学杂志,2018,34(1):31-35.Liu LL,Huang Y,Ma D,et al.Investigation of pathogenesis of IL-17 involved in cytomegalovirus hepatitis[J].Chin J Immunol,2018,34(1):31-35.
[8]汪润民,高萍,杨吉乡,等.脓毒症的免疫学发病机制及对策[J].中国免疫学杂志,2017,33(9):1426-1429.Wang RM,Gao P,Yang JX,et al.Immunological pathogenesis and countermeasures of sepsis[J].Chin J Immunol,2017,33(9):1426-1429.
[9]Terada LS,Hybertson BM,Connelly KG,et al.XO increases neutrophil adherence to endothelial cells by a dual ICAM-1 and P-selectin-mediated mechanism[J].J Applied Physiol,1997,82(3):866-873.
[10]Vallet B,Wiel E.Endothelial cell dysfunction and coagulation[J].Critical Care Med,2001,29(7 Suppl):36-41.
[11]叶新明,钱克俭.重症肺炎支原体肺炎肺泡灌洗液中TNF-α、IL-6、IL-8、IL-10水平观察[J].南昌大学学报(医学版),2010,50(4):72-4.Ye XM,Qian KJ.The study of TNF-α,IL-6,IL-8,IL-10 concentration in critically Ill pneumonia mycoplasma pneumonia patients[J].J Nanchang Univ(Medical Sciences),2010,50(4):72-74.
[12]Yan B,Chen F,Xu L,et al.HMGB1-TLR4-IL23-IL17A axis promotes paraquat-induced acute lung injury by mediating neutrophil infiltration in mice[J].Sci Rep,2017,7(1):597.
[13]王陵,吕韶敏,李俊贤,等.低分子肝素改善COPD急性加重期的价值研究[J].实用药物与临床,2016,19(7):876-878.Wang L,Lv SM,Li JX,et al.Value of low molecular weight heparin in caute exacerbation of COPD[J].Practical Pharmacy Clin Remedies,2016,19(7):876-878.