The Effect Of Anti-inflammatory And Immuno-stimulated Therapies On Th1/Th2 Balance In Septic Patients And Clinical Significance

Objective To detect the level of Th1/Th2 in septic patients in order to monitoring the immune state,as well as to discuss the effect of the anti-inflammatory and immuno-stimulated therapies on Th1/Th2 Balance,as a result,we summarise the clinical experiences of combined therapies so as to probe a new therapeutic method in treating septic patients.Methods 60 septic patients admitted to ICU department of Guangzhou General Hospital of Guangzhou Military Command from 2007.6 to 2008.10 were included and randomly divided into treatment group(n=30) and control group(n=30).The control group received classical treatment according to《Surviving Sepsis Campamgn guidelines for severe sepsis and septic shock 2004》,while the treatment group was given classical treatment plus immunomodulation of u]inastatin and thymic peptideα1. Peripheral blood samples of all patients were collected when the treatment began(on day 1) and ended(on day 10).CD4~+ T cell subset were detected through flow cytometer,and T helper type-1 cell cytokine(IFN-γ~+) and T helper type-2 cell cytokine(IL-4~+) were analyzed semi-quantitatively.As the same time,another 10 healthy volunteers were included as healthy controls.And according to the 28-day survival, the control group was divided into the surviving subgroup and the death subgroup.The levels of IFN-γ+ and IL-4+ of survival subgroup and death subgroup before and after treatment were analyzed,as aresult we summarised the rationality of immunomodulation of ulinastatin and thymic peptideα1.The expression levels of CD14~+ monocyte HLA-DR and APACHEⅡscores of septic patients were collected on day1,day 5,day10 and day28 after admission.The result was analyzed by SPSS13.0.The quantitative data was described as mean±standard,the mean value of 2 groups was compared in t test,the ratio was compared in x~2 test,P＜0.05 was considered as significant difference.Results1.Before the treatment,there is no difference in IFN-γ+ and IL-4 +levels between the treatment group and control group,as well as the ratio of IFN-γ+/IL-4+,CD14~+monocyte HLA-DR expression and APACHEⅡscores(P＞0.05).Both IFN-γ+ and IL-4+levels are higher than that in healthy controls(p＜0.05)2.Compared with the IFN-γ+levels of the same group,it is significantly decreased on day 10 than those on day 1 in the treatment group and control group(p＜0.05).The IFN-γ+ levels on day 10 in the treatment group are significantly higher than those in the control group(p＜0.05).After the treatment,the IL-4+ levels on day 10 are remarkably lower than those on day 1 in the treatment group(p＜0.05),and no differences are found in the control group(p＞0.05).The IL-4+ levels on day 10 in the treatment group are significantly lower than those in the control group(p＜0.05).After the treatment,the ratio of IFN-γ+ /IL-4+ on day 10 are remarkably higher than those on day 1 in the treatment group(p＜0.05),and no differences are found in the control group(p＞0.05).On day 10,the ratio of IFN-γ+/IL-4+ in the treatment group is higher than that in the control group(p＜0.05).The IFN-γ+levels in the death subgroup and surviving subgroup are both declined,with all lower levels in the surviving subgroup.The IL-4+ content in the surviving subgroup is decreased,and it is much lower than that in the death subgroup with an increased tendency.The IFN-γlevels in the death subgroup and surviving subgroup are both declined,with all lower levels in the surviving subgroup.The IL-4~+content in the surviving subgroup is decreased,and it is much lower than that in the death subgroup with an increased tendency.3.CD14~+monoeyte HLA-DR expression on day 10 and day 28 in the treatment sub-group are much higher than that in the control group(P＜0.05).4.APACHEⅡscores on day 10 and day 28 in the treatment sub-group are much lower than those in the control group(P＜0.05).Conclusions1.Septic patients appear to imbalance of Thl-type cytokines(IFN-γ~+) to Th2-type cytokines(IL-4~+) and the imbalance of Th1/Th2 is the important feature of immune disorders in sepsis.2.Giving immuno-modulatory anti-inflammatory and immuno-stimulated therapies could improve Th1/Th2 balance and increase CD14~+monocyte HLA-DR expression,so as to rebuild the cell-mediated immunity as wellas immune state in septic patients.3.Combined anti-inflammatory and immuno-stimulated therapies of TP-α, and ulinastatin could reduce APACHEⅡscores and improve the condition on day 10 and day 28 after the treatment in septic patients.