1 泰州市第二人民医院感染科，江苏 泰州 225500
目的：分析糖皮质激素治疗对感染性休克患者免疫炎症状态及预后的影响，为优化临床治疗方案提供依据。方法：选取2018年1月至2020年8月的160例感染性休克患者作为研究对象，采用随机数字表法将其分为研究组与对照组，每组各80例。对照组给予常规治疗，研究组在常规治疗基础上加用小剂量、长疗程糖皮质激素治疗。对比两组预后情况，检测并分析两组患者入院时、治疗7 d时的免疫炎症指标变化。结果：研究组的28和90 d病死率分别为18.75%和23.75%，均低于对照组，差异有统计学意义(均P<0.05)；在治疗第7天，两组患者的免疫炎症指标均较入院时改善，差异均有统计学意义(均P<0.05)。研究组患者的血清白细胞介素-6(interleukin-6，IL-6)、白细胞介素-10(interleukin 10，IL-10)、肿瘤坏死因子-α (tumor necrosis factor-α，TNF-α)水平的降低幅度分别为(158.35±23.55) pg/mL、(88.16±9.38) pg/mL和(62.25±7.06) pg/mL；外周血CD3+ T淋巴细胞计数、CD4+ T淋巴细胞计数的升高幅度分别为(113.35±15.67)×106/L、(89.04±18.12)×106/L，均大于对照组，差异均有统计学意义(均P<0.05)。结论：针对感染性休克患者，在充分开展常规治疗基础上加用小剂量糖皮质激素治疗，能够有效纠正机体的免疫失衡和炎症反应过激，对于改善预后具有积极作用。
Influences of glucocorticoid therapy on the states of immune and inflammation and prognosis in patients with septic shock
CorrespondingAuthor: LIN Huaide
This work was supported by Taizhou Science and Technology Support Plan Social Development Project, China (ts202004).
Objective: To analyze the influences of glucocorticoid therapy on the states of immune and inflammation and prognosis in patients with septic shock to provide basis for optimizing the clinical treatment plan. Methods: A total of 160 patients with septic shock from January 2018 to August 2020 were selected as the study subjects. They were divided into a study group and a control group with random number table method, 80 cases in each group. The patients in the control group were treated with routine treatment, while the patients in the study group were treated with low dose and long course of glucocorticoid on the basis of routine treatment. The prognosis between the two groups was compared, and the changes of immune and inflammation indexes were detected and analyzed at admission and 7 days after treatment. Results: The 28- and 90-day mortality rates in the study group were 10% and 18.75%, respectively, which were lower than those in the control group. The differences were statistically significant (both P<0.05); at 7 days after treatment, the immune and inflammation indexes of the two groups were both improved, and the differences were statistically significant (both P<0.05). The decreases of serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) in the study group were (158.35±23.55) pg/mL, (88.16±9.38) pg/mL and (62.25±7.06) pg/mL respectively; the increases of CD3+ T lymphocyte count and CD4+ T lymphocyte count in peripheral blood were (113.35±15.67)×106/L and (89.04±18.12)×106/L, respectively, which were higher than those in the control group, and the differences were statistically significant (all P<0.05). Conclusion: For the patients with septic shock, the application of low-dose glucocorticoid on the basis of full routine treatments can effectively correct the immune imbalance and excessive inflammatory response of the body, and has a positive effect on improving prognosis.
glucocorticoid; septic shock; immune and inflammation; prognosis