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目的:研究人感染H7N9禽流感重症患者免疫调理治疗前后淋巴细胞总数和T淋巴细胞亚群的变化及其对预后的影响,为人感染H7N9禽流感重症患者的抢救治疗提供依据。方法:以我院重症医学科2014年1月来收治的确诊人感染H7N9禽流感重症患者11例为研究对象,入院时检测外周血淋巴细胞总数和CD3+T淋巴细胞(CD3+)、辅助性T淋巴细胞(CD3+CD4+)与抑制性T淋巴细胞(CD3+CD8+)计数,在根据国家卫计委《人感染H7N9禽流感诊疗方案(2014年版)》和《人感染H7N9禽流感诊疗方案(2017年第1版)》指导意见的常规治疗基础上每日加用1.6mg胸腺肽α1皮下注射QD-Q12H进行免疫调理治疗,在免疫调理治疗后测定各患者外周血淋巴细胞总数和T淋巴细胞亚群的变化。结果:免疫调理治疗前人感染H7N9禽流感重症患者外周血淋巴细胞总数和CD3+、CD3+CD4+与CD3+CD8+计数均较正常值降低,其中淋巴细胞总数、CD3+、CD3+CD4计数明显降低(P<0.05);免疫调理治疗后患者外周血淋巴细胞总数和CD3+、CD3+CD4+与CD3+CD8+计数均较治疗前升高,其中淋巴细胞总数、CD3+与CD3+CD8+计数显著升高(P<0.05)。结论:人感染H7N9禽流感重症患者均有淋巴细胞总数减少,T淋巴细胞亚群降低等免疫失衡的表现,胸腺肽α1免疫调理治疗能增加患者淋巴细胞总数和T淋巴细胞亚群,纠正免疫失衡状态,提高抢救成功率。
Objective: To study the changes of total lymphocyte count and T lymphocyte subsets and its prognosis before and after immunomodulatory treatment of severe H7N9 bird flu infection, and to provide evidence for the rescue and treatment of severe H7N9 bird flu infection. Methods: Totally 11 patients diagnosed as H7N9 bird flu were admitted to our hospital from January 2014 to January 2014. The total number of peripheral blood lymphocytes and CD3 + T lymphocytes (CD3 +), T (CD3 + CD4 +) and suppressor T lymphocytes (CD3 + CD8 +) were counted. According to the report of the State Health Planning Commission’s Human On H7N9 Bird Flu Treatment and Treatment Program (2014 Edition) and Human H7N9 Avian Influenza Treatment and Treatment Program (2017) Year first edition) guidelines on the basis of routine daily plus 1.6mg thymosin α1 subcutaneously injected QD-Q12H immunomodulatory therapy in immunosuppression therapy to determine the total number of peripheral blood lymphocytes and T lymphocyte subsets The change. Results: The total number of peripheral blood lymphocytes and the counts of CD3 +, CD3 +, CD4 + and CD3 + CD8 + in H7N9 severe acute respiratory syndrome patients treated with immunomodulatory treatment were lower than those in normal control group. The total number of lymphocytes, CD3 + and CD3 + <0.05). The total number of peripheral blood lymphocytes and the counts of CD3 +, CD3 +, CD4 + and CD3 + CD8 + in patients with immunosuppression were significantly higher than those before treatment, and the total number of lymphocytes, the counts of CD3 + and CD3 + CD8 + were significantly increased (P <0.05 ). Conclusion: H7N9 bird flu severe patients have reduced the total number of lymphocytes, T lymphocyte subsets and other immune imbalances, thymosin α1 immunomodulatory therapy can increase the total number of patients with lymphocytes and T lymphocyte subsets, to correct the immune imbalance , Improve the success rate of rescue.