论文部分内容阅读
目的研究免疫调理治疗对严重创伤和感染的作用机制及疗效。方法采用前瞻、随机、单盲和对照的方法临床研究分析108例严重创伤和感染的患者,随机分为对照组(40例)和治疗组(68例)。对照组采用常规治疗;治疗组常规治疗联合使用蛋白酶抑制剂免疫调理,免疫调理疗程为7 d。分别观察治疗前及治疗后1、3、7、14 d淋巴细胞计数和CD14+单核细胞人白细胞DR抗原(HLA-DR)水平的动态变化,并收集住院期间的临床资料。结果住院期间对照组死亡28例,治疗组死亡26例,两组病死率比较差异有统计学意义(P<0.05)。治疗组淋巴细胞计数和CD14+单核细胞HLA-DR水平在7、14 d时均较对照组显著升高(P<0.05),脏器功能障碍数、脓毒症发生率均较对照组明显减少(P<0.05)。结论免疫调理治疗可以升高严重创伤和感染患者淋巴细胞计数和CD14+单核细胞HLA-DR水平,从而改善免疫麻痹,降低脏器功能障碍和脓毒症发生率及病死率。
Objective To study the mechanism and effect of immunomodulatory therapy on severe trauma and infection. Methods A total of 108 patients with severe trauma and infection were randomly divided into control group (n = 40) and treatment group (n = 68) by prospective, randomized, single blind and controlled clinical trial. The control group was treated routinely. The treatment group received routine immunotherapy with protease inhibitor, and the immunostimulation course was 7 days. The changes of lymphocyte count and the level of HLA-DR of CD14 + monocytes were observed before and after treatment, and the clinical data were collected during hospitalization. Results During the hospitalization, 28 patients died in the control group and 26 patients died in the treatment group. There was significant difference in the case fatality rate between the two groups (P <0.05). The lymphocyte count and HLA-DR level of CD14 + monocytes in treatment group were significantly higher than those in control group at 7 and 14 days (P <0.05), and the number of organ dysfunction and the incidence of sepsis were significantly lower than those in control group (P <0.05). Conclusion Immunomodulatory therapy can increase lymphocyte count and HLA-DR level of CD14 + monocytes in patients with severe trauma and infection, thereby improving immune paralysis, reducing organ dysfunction and sepsis incidence and mortality.