Effects of thymosin combined with bedside high flow CBP on serum HBP and HO-1 and hemodynamic parameters in patients with sepsis
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摘要: 目的 探讨胸腺肽结合床旁高流量连续性血液净化(continuous blood purification，CBP)治疗脓毒症患者对其血清肝素结合蛋白(heparin binding protein，HBP)、血红素加氧酶-1(heme oxygenase-1，HO-1)及血流动力学参数的影响。方法 选取2021年7月—2022年3月于邢台市第三医院收治的88例脓毒症患者，依据随机数表法将患者分为O组及C组，44例C组患者给予床旁高流量CBP，在C组的基础上44例O组患者给予胸腺肽皮下注射，两组患者治疗2周后比较患者临床疗效、T细胞亚群、炎症因子、血清HBP、HO-1水平及血流动力学参数。结果 O组患者的临床总有效率为88.64%(39/44)，明显高于C组的临床总有效率(70.45%，31/44)，两组差异有统计学意义(P < 0.05)。与C组患者治疗后比较，O组患者的CD3+及CD4+水平更高，CD8+水平更低，两组差异有统计学意义(P < 0.05)。O组患者的TNF-α及IL-6水平低于C组，两组差异有统计学意义(P < 0.05)。O组患者治疗后，HBP水平低于C组，两组差异有统计学意义(P < 0.05)；HO-1水平和SVR水平均高于C组，两组差异有统计学意义(均P < 0.05)。结论 胸腺肽结合床旁高流量CBP有利于减轻脓毒症患者的炎症反应、对于机体免疫功能与血流动力学均具有积极的作用，有利于降低HBP水平的表达及提高HO-1水平的表达，具有确切的疗效。Abstract: Objective To investigate the effects of thymosin combined with bedside high flow continuous blood purification(CBP) on serum heparin binding protein(HBP), heme oxygenase-1(HO-1) and hemodynamic parameters of septic patients treated with CBP.Methods Eighty-eight patients with sepsis admitted to the Third Hospital of Xingtai from July 2021 to March 2022 were selected and divided into Group O and Group C according to random number table method. Forty-four patients in group C were given high-flow bedside CBP, and 44 patients in group O were given subcutaneous injection of thymosin on the basis of group C. After 2 weeks of treatment, the clinical efficacy, T cell subsets, inflammatory factors, serum HBP, HO-1 levels and hemodynamic parameters of the patients were compared.Results The total clinical effective rate in observation group was 88.64%(39/44) higher than 70.45%(31/44) in control group, and the differences were statistically significant(P < 0.05).Comparison with patients in the control group after treatment, the levels of CD3+ and CD4+ in observation group were higher, and the levels of CD8+ were lower, and the differences were statistically significant(P < 0.05). The levels of TNF-α and IL-6 in observation group were lower than control group, and the differences were statistically significant(P < 0.05).HBP level in observation group was lower than control group after treatment, and the differences were statistically significant(P < 0.05).And HO-1 level in observation group was higher than control group after treatment, and the differences were statistically significant(P < 0.05).The SVR level of observation group was higher than control group after treatment, and the differences were statistically significant(P < 0.05).Conclusion Thymosin combined with bedside high-flow CBP is beneficial to reduce the inflammatory response of sepsis patients, and has a positive effect on immune function and hemodynamics of the body. It is beneficial to reduce the expression of HBP level and increase the expression of HO-1 level, which has a definite curative effect.
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Key words:
- thymosin /
- high flow blood purification /
- sepsis /
- heparin binding protein /
- heme oxygenase-1 /
- hemodynamics
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表 1 临床疗效比较
例(%) 组别 显效 有效 无效 总有效率 O组(44例) 23(52.27) 16(36.36) 5(11.36) 39(88.64) C组(44例) 22(50.00) 9(20.45) 13(29.55) 31(70.45)1) χ2 4.470 P 0.034 与O组比较，1)P < 0.05。 
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表 2 两组T细胞亚群比较
X±S 组别 治疗前 治疗后 CD3+ CD4+ CD8+ CD3+ CD4+ CD8+ O组(44例) 42.33±4.59 30.09±3.88 28.67±5.33 69.98±5.881) 44.34±4.331) 18.92±5.221) C组(44例) 42.39±4.61 30.11±3.92 28.71±5.41 56.23±5.011) 41.22±4.671) 14.23±5.111) t 0.061 0.024 0.035 11.807 3.250 4.259 P 0.951 0.981 0.972 < 0.001 0.001 < 0.001 与治疗前比较，1)P < 0.05。
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表 3 两组炎症因子比较
pg/mL，X±S 组别 治疗前 治疗后 TNF-α IL-6 TNF-α IL-6 O组(44例) 156.49±23.45 202.34±37.45 99.27±18.971) 147.34±24.891) C组(44例) 158.32±23.55 202.39±37.49 121.09±16.751) 171.09±29.921) t 0.365 0.006 5.719 4.048 P 0.716 0.995 < 0.001 0.001 与治疗前比较，1)P < 0.05。
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表 4 两组血清HBP及HO-1水平比较
ng/mL，X±S 组别 治疗前 治疗后 HBP HO-1 HBP HO-1 O组(44例) 93.23±19.02 249.49±23.11 39.93±10.221) 403.23±42.991) C组(44例) 94.06±19.11 251.01±23.17 47.98±11.371) 364.30±31.211) t 0.204 0.308 3.493 4.861 P 0.839 0.759 < 0.001 0.001 与治疗前比较，1)P < 0.05。
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表 5 两组血流动力学比较
X±S 组别 治疗前 治疗后 MAP/mmHg HR/(次/min) SVR MAP/mmHg HR/(次/min) SVR O组(44例) 62.39±11.23 118.23±31.18 66.31±18.77 95.07±20.11 90.09±12.11 107.79±10.221) C组(44例) 62.66±11.19 119.92±30.99 67.09±18.81 93.24±21.98 91.72±12.87 91.22±12.271) t 0.113 0.255 0.220 0.408 0.612 6.486 P 0.910 0.799 0.827 0.685 0.542 < 0.001 注：1 mmHg=0.133 kPa；与治疗前比较，1)P < 0.05。
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