小剂量糖皮质激素对严重脓毒症患者CRP、CD64指数和HLA-DR水平的影响
Effect of low dose glucocorticoid on CRP、CD64 index and HLA-DR level in patients with severe sepsis

喻秋平,杨蕙文,叶兴文,李力,罗洋,刘松.小剂量糖皮质激素对严重脓毒症患者CRP、CD64指数和HLA-DR水平的影响[J].内科急危重症杂志,2017,23(4):

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英文关键词:Glucocorticoid severe sepsis CRP CD64 HLA-DR

基金项目:江西省卫生厅科技项目课题(编号：20177137)

作者	单位	E-mail
喻秋平	九江学院附属医院ICU	yu_88@sohu.com
杨蕙文	九江学院附属医院ICU
叶兴文	九江学院附属医院ICU
李力	九江学院附属医院ICU
罗洋	九江学院附属医院ICU
刘松	九江学院附属医院ICU

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中文摘要:

目的探讨严重脓毒症患者早期应用小剂量糖皮质激素,对炎症反应指标和免疫功能指标的影响。方法将95例确诊严重脓毒症患者随机分为激素组(n=49)和非激素组(n=46)。激素组在综合治疗基础上给予氢化可的松100mg/bid,持续静脉滴入,连续给药7天。观察二组患者入院时生命体征,抽取静脉血检测二组患者入院时及入院第1、3、5、7天患者血CRP、中性粒细胞CD64及单核细胞HLA-DR水平。结果 1. 二组患者治疗后CRP均较治疗前降低,治疗后激素组各时点数据均低于非激素组,二组比较差异有显著性(P<0.01)；2. 治疗后二组患者外周血中性粒细胞CD64比较,自治疗第3天始,激素组各时点数据均低于非激素组,差异有非常显著性(P<0.01)；3. 治疗后二组患者单核细胞HLA-DR表达水平比较,治疗第3天,二组患者比较差异有显著性(P<0.05)；第5、7天二组患者差异非常有显著性(P<0.01)。结论严重脓毒症患者早期即出现严重全身炎症反应及免疫功能抑制；严重脓毒症患者早期使用小剂量糖皮质激素,可以显著抑制全身炎症反应,同时有助于改善患者免疫功能。

英文摘要:

Objective To explore the effect of low dose glucocorticoid on inflammatory response and immune function in patients with severe sepsis. Methods 95 patients with severe sepsis were randomly divided into two groups: hormone group（n=49） and non - hormone group（n=46）. Hormone group on the basis of comprehensive treatment given hydrocortisone 100mg / bid, continuous intravenous infusion, continuous administration of 7 days. The serum levels of CRP, neutrophil CD64 and the level of HLA-DR in mononuclear cells of the patients in the two groups were measured at the time of admission and on the 1st, 3rd, 5th and 7th day after admission. Results 1.The levels of CRP in the two groups were lower than those in the non-steroid group at each time point after treatment (P <0.01).2. After treatment, the CD64 levels of neutrophils in peripheral blood of the two groups were compared, From the 3rd day of the treatment, the data of the hormone group were lower than the non-hormone group at each time point, the difference was very significant(P<0.01).3. After treatment, the levels of HLA-DR expression in monocytes were compared between the two groups On the third day, there were significant differences between the two groups(P<0.05), On the 5th and 7th day, the difference between the two groups was very significant(P<0.01). Conclusions Serious sepsis in patients with early severe systemic inflammatory response and immune suppression; Severe sepsis early use of small doses of glucocorticoids, can significantly inhibit systemic inflammatory response, while helping to improve immune function in patients.