The Effect Of Ulinastatin On The Drift Of Th1/Th2 In Sepsis Patients

Purpose: Discussion on the effect of the expression of blood T cell transcription factors T-bet and GATA-3 in the Patients with sepsis who use Ulinastatin, to investigate the effect of ulinastatin on the immune response and its possible mechanism.Methods: Select the definitive diagnosis of sepsis patients in the first hospital affiliated with Dalian medical university during the period of June 2014 to December 2014. According to the random digital method, the patients who met the inclusion criteria were divided into contrast group and treatment group. The contrast group and treatment group respectively collected eleven sepsis patients.Six people were included in the contrast group and eight people were included in the treatment group at last.Contrast group, according to the “2012 international Guidelines for Management of Severe Sepsis and Septic Shock”[1], patients were given anti infection, rehydration correct electrolyte disorder, nutritional support, treatment of the primary disease and other routine treatment; Treatment group : on the basis of routine treatment combined with Ulinastatin 100000 u intravenous injection, 2 times / day, continuous application at least 7 days.Recording the basic information such as age 、 gender and the APACHE II score, to test the show of transcription factor T – bet, GATA – 3 in the peripheral blood mononuclear cell(PBMC) and the INF-γ、IL-4 level in serum before treatment and 1day, 3days, 7days after treatment, taking T-bet/GATA-3 and NF-γ/IL-4 as evaluation index of Th1 / Th2 drift direction, to discuss the effect of Ulinastatin on blood Th1 / Th2 drift direction.The expression of transcription factor T-bet and GATA-3 were detceted by RT-PCR,the serum levels of cytokines IFN-γ and IL-4 were detected by enzyme linked immunosorbent assay( ELISA) for all the subjects.Results:Transcription factor T-bet, in Contrast group and Ulinastatin group, showed an upward trend 1 day after treatment,the upward trend of Ulinastatin group is smaller,thedifference had statistical significance;The two group also rise 3 day after the treatment, the difference had no statistical significance;both decrease 7 day after treatment,the difference had no statistical significance.Transcription factor GATA-3 in Contrast group and Ulinastatin group, both showed an upward trend 1 day after treatment, the upward trend of Ulinastatin group is obviously, but the difference had no statistical significance;The two group also rise 3day after the treatment,he difference had no statistical significance;Till 7 days after treatment,both showed a downward trend, the difference had no statistical significance. Cytokine IFN-γ in Contrast group and Ulinastatin group, both showed an upward trend 1 day after treatment, the rising trend of ulinastatin group is smaller, the difference had statistical significance; the two group also showed a upward trend after treatment in 3 days after treatment,the difference had no statistical significance;both decrease 7 day after treatment,the difference had no statistical significance.Cytokine IL-4 in Contrast group and Ulinastatin group, both showed an upward trend 1day after treatment, the upward trend of Ulinastatin group is bigger, but with no statistical significance;the two group also showed a upward trend after treatment in 3 days after treatment,the difference had no statistical significance;till 7days after treatment, both showed a downward trend, had no statistical significance.Transcription factor T-bet/GATA-3 in Contrast group showed a upward trend after treatment in 1 day, Ulinastatin group showed a downwardtrend,but with no statistical significance;3 day after treatment,both showed a downward trend,had no statistical significance;Till 7 days after treatment, both showed a upward trend, the upward trend of Ulinastatin group is bigger,the difference between two groups had statistical significance.IFN-γ/IL-4 in Contrast group showed a upward trend after treatment in 1 day, Ulinastatin group showed a downwardtrend,but with no statistical significance;3 day after treatment,both showed a downward trend,with no statistical significance;till 7 days after treatment, both showed a upward trend, the upward trend of Ulinastatin group is bigger,the difference between two groups had statistical significance. APACHEII scores both decreased in Contrast group and Ulinastatin group 7 days after treatment,the downward trend of Ulinastatin group is bigger, and the difference had statistical significance.Conclusions: Ulinastatin can reduce the early excessive inflammation reaction of the patients with severe sepsis, but without causing the excessive enhancement of patients’ anti-inflammatory effect. It maybe improve patients’ drift from Th1 to Th2, may have a role maintaining the patients’ stability of immune function. Because of the number of cases is too small in this study, we still need to expand the number of the cases, to further clarify the immune regulation effect of ulinastatin and safety.