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目的分析小剂量甲泼尼龙对脓毒血症患者疗效及对免疫细胞的影响。方法回顾性分析2014年10月—2016年10月到普陀区利群医院诊治的脓毒血症患者共72例,每组36例,对照组患者给予常规抗感染治疗,观察组患者在此基础上配合小剂量甲泼尼龙治疗,均连续治疗7 d,比较两组患者疗效和治疗前后免疫细胞、炎症因子水平。结果观察组患者生存率为80.56%,明显高于对照组的55.56%,差异有统计学意义(P<0.05),并发症发生率未表现出明显差异。治疗前两组患者免疫细胞水平未表现出明显差异,治疗后观察组CD4~+T淋巴细胞、CD8~+T淋巴细胞均明显高于对照组,CD4~+/CD8~+明显低于对照组,组间差异有统计学意义(P<0.05);治疗后观察组血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、白细胞介素-1(IL-1)等炎症因子水平均明显低于对照组,差异有统计学意义(P<0.05)。结论小剂量甲泼尼龙用于脓毒血症患者疗效确切,能够有效调节T淋巴细胞和炎症因子水平,降低机体免疫反应,提高生存率,推荐临床推广应用。
Objective To analyze the effect of low dose methylprednisolone on immune cells in patients with sepsis. Methods A retrospective analysis of 72 patients with sepsis diagnosed and treated in Liqun Hospital of Putuo District from October 2014 to October 2016 was conducted in 36 patients in each group. Patients in the control group were given conventional anti-infective therapy and the patients in the observation group were on this basis With a small dose of methylprednisolone treatment were continuous treatment of 7 d, the efficacy of two groups of patients and compared before and after treatment of immune cells, inflammatory cytokines levels. Results The survival rate of the observation group was 80.56%, which was significantly higher than that of the control group (55.56%), the difference was statistically significant (P <0.05). The incidence of complications did not show significant difference. The levels of CD4 ~ + T lymphocytes and CD8 ~ + T lymphocytes in the observation group were significantly higher than those in the control group after treatment, and the levels of CD4 ~ + / CD8 ~ + in the two groups were significantly lower than those in the control group (P <0.05). The levels of serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), interleukin-1 (IL-1) and other inflammatory factors were significantly lower than the control group, the difference was statistically significant (P <0.05). Conclusion Low dose methylprednisolone is effective in patients with sepsis, which can effectively regulate the level of T lymphocytes and inflammatory cytokines, reduce the immune response and improve the survival rate. It is recommended for clinical application.