[1]满明昊 李立宏 杨彦龙 李 敏 郭少春.颅脑损伤术后细胞免疫指标变化及脾多肽对其影响[J].中国临床神经外科杂志,2016,(06):362-365.[doi:10.13798/j.issn.1009-153X.2016.06.014]
 MAN Ming-hao,LI Li-hong,YANG Yan-yong,et al.Changes in peripheral cells immunity after operation and effect of spleen polypeptide on them in patients with traumatic brain injury[J].,2016,(06):362-365.[doi:10.13798/j.issn.1009-153X.2016.06.014]
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颅脑损伤术后细胞免疫指标变化及 脾多肽对其影响()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2016年06期
页码:
362-365
栏目:
论著
出版日期:
2016-06-25

文章信息/Info

Title:
Changes in peripheral cells immunity after operation and effect of spleen polypeptide on them in patients with traumatic brain injury
文章编号:
1009-153X(2016)06-0362-04
作者:
满明昊 李立宏 杨彦龙 李 敏 郭少春
710038 西安,第四军医大学唐都医院神经外科(满明昊、李立宏、杨彦龙、李 敏、郭少春)
Author(s):
MAN Ming-hao LI Li-hong YANG Yan-yong LI Min GUO Shao-chun.
Department of Neurosurgery, Tangdu Hospital, The fourth Military Medical University, Xi’an 710038, China
关键词:
颅脑损伤手术免疫抑制脾多肽
Keywords:
Traumatic brain injury Nosocomial infections Immune suppression Spleen polypeptide
分类号:
R 651.1+5; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2016.06.014
文献标志码:
A
摘要:
目的 探讨颅脑损伤术后外周血免疫指标变化及免疫调节剂脾多肽对其影响。方法 2014年6月至2015年6月开展一项单中心、随机、对照、单盲的临床试验,纳入符合入组标准的颅脑损伤60例,随机分为脾多肽组(30例)和对照组(30例)。脾多肽组急诊行去骨瓣减压术26例,单纯脑室外引流术4例;对照组急诊行去骨瓣减压术25例,单纯脑室外引流术5例。脾多肽组术后静脉滴注10 ml脾多肽(用250 ml 5%葡萄糖稀释),1次/d,连续7 d;对照组术后给予10 ml生理盐水(用250 ml 5%葡萄糖稀释)。主要观察指标为感染发生率,统计时段为患者在接受治疗至搬离监护室时间,超出28 d的以28 d为终点;次要观察指标为反应免疫状态的一系列指标,包括白细胞计数及分类、白细胞介素(IL)-2、IL-4、IL-6、IL-12、γ-干扰素(IFN-γ)、儿茶酚胺(CA)浓度及全血CD14或mHLA-DR阳性细胞比例。结果 脾多肽组感染发生率(20.0%,6/30)明显低于对照组(46.7%,14/30;P <0.05);而且,脾多肽组耐药菌株比例(33.3%,2/6)明显低于对照组(57.1%,8/14;P <0.05)。脾多肽组监护室住院时间最长为24 d,对照组截止28 d仍有7例未转出监护室;但是Kaplan-Meier生存分析显示两组监护室住院时间无统计学差异(P>0.05)。脾多肽组28 d GOS评分[(2.6±0.5)分]与对照组[(2.9±0.5)分]无统计学差异(P>0.05)。治疗前,两组外周血免疫指标无统计学差异(P>0.05);治疗后1周,脾多肽组外周血单核细胞细胞数、CD14阳性细胞比例、IL-12水平均明显增高(P <0.05),而外周血IL-2水平明显降低(P <0.05)。结论 脾多肽可改善颅脑损伤术后被抑制的免疫功能,降低感染率,但并不影响患者总体预后。
Abstract:
Objective To study the changes in the peripheral cells immunity after the operation in the patients with traumatic brain injury (TBI) and observe the effect of immunomodulator, spleen polypeptide (SP) on them. Methods we performed a single-center, randomized, controlled, single-blind clinical trial from Jun 10, 2014 to July 1, 2015. Sixty eligible patients with TBI undergoing neurosurgery in neurosurgical intensive care unit (NICU) were randomly divided into the control group (n=30) in which the patients received an intravenous infusion of 250 ml 5% glucose solution per day for 7 days and SP treatment group (n=30) in which the patients received an intravenous infusion of 250 ml 5% glucose solution containing 10 ml SP per day for 7 days. The immunological indexes in the peripheral venous blood were determined before the treatment and 7 days after the treatment and the infectious rates were observed in both the groups. Results The infectious rate (20.0%) was significantly lower in SP treatment group than that (46.7%) in the control group (P <0.05). The levels of monocytes, CD14 and interleukin (IL) 12 expressions in the peripheral venous blood were significantly higher SP treatment group than those control group 7 days after the treatment (P <0.05). The levels of norepinephrine (NA) and IL-2 expressions in the peripheral venous blood was significantly lower in SP treatment groups than in those in the in the control group (P <0.05). However, there were insignificant differences in hospital stay in NICU and GOS 28 days after the treatment between both the groups (P>0.05). Conclusions SP treatment can be helpful to improving the impaired immune function in the patients with TBI, in whom its effect on the prognosis is significant.

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更新日期/Last Update: 2016-06-20