|
|
|
|
|
| The clinical efficacy and the effect on lymphocyte subsets of different doses of methylprednisolone in the treatment of children with septic shock in decompensation stage |
| Lin Hai, Wang Zi-jing, Wang Shi-biao, Kang Yu-lan, Lin Min, Weng Bin, Sun Peng-ming |
| Department of Pediatric Intensive Care Unit, Fujian Provincial Maternity and Children′s Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, China |
|
|
|
|
Abstract Objective To investigate the therapeutic effects of different dosages of methylprednisolone (MP) on the children with septic shock (SS) in decompensation stage, and analyze the changes of lymphocyte subsets. Methods 78 children with SS in decompensation stage were randomly divided into three groups according to the MP initial dosages: the high-dosage group ［20 mg/(kg·d), n=26］, the middle-dosage group ［5 mg/(kg·d), n=26］ and the low-dosage group ［2 mg/(kg·d), n=26］. The MP dosages were reduced gradually after a week. The therapeutic effects of the three groups were recorded. The peripheral blood lymphocyte subsets of the three groups were analyzed on Day 1, 3, 8 in hospital and compared with those of 26 healthy controls. Results The length of stay of the low -dosage group and the middle -dosage group were statistically shorter than that of the high-dosage group (d: 16.760±1.895，16.610±1.852 vs. 18.770±2.707, P=0.002). The SS correct time（h: 2.557±0.379,2.419±0.374 vs. 3.992±0.427）, fever clearance time(d: 1.507±0.393,1.500±0.405 vs. 2.334±0.430) and the time of vasoactive drug used（d: 2.707±0.308,2.526±0.294）vs.4.338±0.456) in the middle-dosage group and the high-dosage group were obviously decreased compared with t the low- dosage group (F=35.502～199.102, P=0.000). The mortality of the three groups were not statistically significant (P＞0.05). The double infect of the high-dosage group was statistically more than those of the middle-dosage group and the low-dosage group (χ2=10.685, P=0.005). On the first day of admission, the three groups with SS in decompensation stage had statistical decrease of peripheral blood lymphocyte subsets compared with control group (F=154.805～5841.727, P=0.000), but there were not significant differences among the three groups (P＞0.05). On the third day of admission, the peripheral blood lymphocyte subsets on the three groups obviously decreased, CD4+T, CD3+T and lymphocyte count in the low-dosage group and the middle-dosage group were significantly higher than those of the high-dosage group (F=909.269～1815.873, P=0.000). On the eighth day of admission, the peripheral blood lymphocyte subsets in the three groups increased, CD4+T, CD8+T, CD3+T and lymphocyte count in the low-dosage group and the middle-dosage group were significantly higher than those of the high-dosage group (F=211.492～1991.729, P=0.000). The peripheral blood lymphocyte subsets in the death children were significantly lower than the survival children in the three groups on day 1 and 3 after admission (F=108.213～3521.472, P=0.000). Conclusion The low-dosage of MP can be used to guide the therapy of children with SS in decompensation stage, which can control the inflammation and shorten hospital stays, decrease apoptosis of CD4+T- based.
|
|
|
| About author:: Lin Hai, E-mail: linhai652@163.com |
|
|
|
| ［1］de Oliveira CF, Troster EJ, Carcillo JA, et al. A beneficial role of central venous oxygen saturation-targeted septic shock management in children： Follow the pediatric story,not only the adult story［J］. Pediatr Crit Care Med, 2014, 15(4):380-382.
［2］刘贇.儿童脓毒症休克的诊疗进展［J］.实用临床医学, 2016, 17 (7) :97-101.没查到
［3］龙盼,李响,姜丽静,等.脓毒症休克患者临床免疫功能分析［J］.重庆医学, 2017, 46 (2) :198-200.
［4］孙杭,张宪伟. 脓毒症患儿免疫抑制与多器官功能障碍相关性研究［J］.临床儿科杂志, 2017, 35(11):832-836.
［5］李娜,陆士奇. 糖皮质激素在百草枯致急性肺损伤中应用的研究进展［J］.中国急救医学, 2008, 28(2):170-172.
［6］Park HY, Suh GY, Song JU, et al. Early initiation of low-dose corticosteroid therapy in the management of septic shock:a retrospective observational study［J］. Crit Care, 2012, 16 (1) :R3.
［7］中华医学会儿科学分会急救学组,中华医学会急诊医学分会儿科组,中华儿科杂志.儿科感染性休克(脓毒性休克)诊疗推荐方案［J］.中国小儿急救医学, 2006, 13(4) :313-315.
［8］马晓春,陈铭铭.持续性炎症-免疫抑制分解代谢综合征-ICU滞留患者炎症、免疫及代谢状态新解说［J］.中国危重病急救医学, 2012, 24(9):514-516.
［9］Flohé SB, Agrawal H, Schmitz D, et al. Dendritic cells during polymicrobial sepsis rapidly mature but fail to initiate a protective Th1-type immune response［J］. J Leukoc Biol, 2005, 79 (3) :473-481.
［10］Hotchkiss RS, Tinsley KW, Swanson PE, et al. Depletion of dendritic cells,but not macrophages,in patients with sepsis［J］. Immunol, 2002, 168（5）:2493-2500.
［11］林海,王子敬,王世彪,等. 脓毒性休克患儿外周血淋巴细胞亚群的动态变化及临床意义［J］.国际儿科学杂志, 2016, 43(2) :138-140，144.
［12］陈涛，臧彬.脓毒症及脓毒性休克患者T淋巴细胞亚群变化研究［J］.临床军医杂志, 2017, 45(1)46-48.
［13］李鑫,杨蕊,臧强，等.糖皮质激素的药理作用机制研究进展［J］.国际药学研究杂志, 2009, 36(1)27-30.
［14］于泳浩,崔乃强,傅强，等.脓毒症患者促炎／抗炎反应和下丘脑－垂体－肾上腺轴变化与脓毒性休克预后的关系［J］.中华急诊医学杂志， 2003, 12(7):470-473.
［15］Keh D, Boehnke T, Weber-Cartens S, et al. Immunologic and hemodynamic effects of “low-dose” hydrocortisone inseptic shock: a double-blind, randomized, placebo- controlled,crossover study［J］. Am J Respir Crit Care Med, 2003, 167(4)：512-520．
［16］朱进,李秀华,钱燕宁.不同剂量糖皮质激素对外周血CD4+T 淋巴细胞凋亡的影响［J］.江苏医药, 2008, 34(9)875-876,插1页. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
