血必净注射液对严重脓毒症患者免疫调理机制的影响

Effect of Xuebijing injection on immune regulation in patients with severe sepsis

关键词:  脓毒症  血必净  T-bet  GATA-3  IFN-γ  IL-4

Key words:  sepsis  Xuebijing  T-bet  GATA-3  IFN-γ  IL-4

摘要:

目的　观察血必净注射液对严重脓毒症患者Th1细胞转录因子T-bet mRNA和Th2细胞转录因子GATA-3 mRNA表达的影响，探讨其能否通过影响Th1/Th2漂移来调理严重脓毒症患者的免疫紊乱。方法　将15例严重脓毒症患者分为血必净治疗组（n=9）和常规治疗组（n=6）。常规治疗组给予脓毒症的一般治疗，包括液体复苏、抗感染、必要时呼吸机辅助治疗以及营养支持等。血必净治疗组在相同的常规治疗基础上加用血必净注射液（100 mL，2次/d，应用7 d）。两组分别于入院当天（0 d）和入院后第1、3和7 天抽外周静脉血；应用Real-time RT-PCR检测T-bet和GATA-3 mRNAs；ELISA法检测血Th1分泌的IFN-γ和Th2分泌的IL-4；并同时进行APACHE II评分。结果　常规治疗组患者入院第3 天和第7 天的血IFN-γ、T-bet mRNA、T-bet/GATA-3、IFN-γ/IL-4均明显高于0 d（均P<0.05），GATA-3 mRNA和IL-4明显低于0 d（均P<0.05）；血必净注射液治疗后第3 天和第7天患者的血IFN-γ、T-bet mRNA、T-bet /GATA-3、IFN-γ/IL-4明显低于常规治疗组（均P<0.05），GATA-3 mRNA和IL-4明显高于常规治疗组（均P<0.05）。血必净注射液治疗后第7 天 APACHE II评分较常规治疗组显著下降（18.22±1.99 vs. 22.67±2.16，P=0.042）。结论　严重脓毒症患者存在Th1/Th2 失衡；血必净注射液能通过抑制T-bet mRNA表达和促进GATA-3 mRNA表达来改善Th1/Th2 失衡和缓解病情的严重程度。

Abstract:

Objective To observe the effect of Xuebijing injection on the expressions of Th1 lymphocyte transcription factor T-bet mRNA and Th2 lymphocyte transcription factor GATA-3 mRNA and thus investigate its possible mechanism of immune regulation by affecting Th1/Th2 shift in patients with severe sepsis. Methods Fifteen severe septic patients were randomly divided into Xuebijing treatment group (n=9) and conventional therapy group (n=6). The patients in the conventional therapy group received the conventional treatments for sepsis, including fluid resuscitation, antibiotic therapy, mechanical ventilation if necessary, nutrient support and so on. Based on the same treatment as conventional therapy group, the patients in the Xuebijing treatment group received Xuebijing treatment (100 mL, twice, for 7 days). Peripheral venous blood was drawn from the patients in the two groups on admission and days 1,3 and 7, the expressions of T-bet and GATA-3 mRNAs were tested by Real-time RT-PCR,blood IFN-γ secreted by Th1 and IL-4 secreted by Th2 were tested by ELISA, meanwhile APACHE II scores were assessed. Results The patients in the conventional therapy group showed higher blood levels of IFN-γ, T-bet mRNA, T-bet /GATA-3 and IFN-γ/IL-4 on days 3 and 7 and lower levels of GATA-3 mRNA and IL-4 compared with those on day 0 (all P<0.05). The patients in the Xuebijing treatment group had the decreased blood levels of IFN-γ, T-bet mRNA, T-bet /GATA-3 and IFN-γ/IL-4 and the increased blood levels of GATA-3 mRNA and IL-4 compared with the patients in the conventional therapy group on days 3 and 7 (all P<0.05). The APACHE II scores were significantly decreased in the Xuebijing treatment group compared with the conventional therapy group on day 7 (18.22±1.99 vs. 22.67±2.16, P=0.042). Conclusions Patients with severe sepsis has an imbalance of Th1/Th2. Xuebijing injection improves the imbalance of Th1/Th2 and the severity of sepsis by inhibiting the expression of T-bet mRNA and improving the expression of GATA-3mRNA.