| Citation: |
ZHONG Weixi, YANG Yanping, HUANG Guandong, YANG Kaichao, HUANG Jianyin, WU Wei, FENG Qiming. Effect of thymus pentapeptide injection on immune function and postoperative infection in patients with open fractures of lower extremity[J]. Journal of Clinical Medicine in Practice, 2022, 26(17): 72-76. DOI: 10.7619/jcmp.20221370
|
To investigate effect of thymus pentapeptide injection on immune function and postoperative infection in patients with open fractures of lower extremity.
The clinical data of 60 patients with Gustilo-Anderson type Ⅲ open fracture of lower extremity admitted to the emergency intensive care unit of Shanghai Jiao Tong University Affiliated to Sixth People′s Hospital were collected. The patients were divided into infected group (n=8) and non-infected group (n=52) according to whether postoperative infection occurred or not, and were divided into experimental group (n=42) and control group (n=18) according to whether they received treatment of injection of thymopentin or not. The control group received routine treatment, while the experimental group received intramuscular injection of thymopentin for 20 mg once a day for 7 days on the basis of routine treatment. The levels of lymphocytes and subsets were compared between the infected group and the non-infected group. The changes of immune function indexes and the occurrence of postoperative infection were observed between the experimental group and the control group.
Of 60 patients with lower extremity open fracture, 8 patients developed wound infection after operation. A total of 17 strains were isolated, including 5 strains of Klebsiella pneumoniae, 4 strains of Pseudomonas aeruginosa, 3 strains of Acinetobacter baumannii, 2 strains of Enterococcus faecium, 1 strain of Staphylococcus aureus, 1 strain of Escherichia coli and 1 strain of Enterobacter cloacae. On the 7th day after injury, the proportions of CD3 and CD4 cells in the infected group were lower than those in the non-infected group (P < 0.05). The infection rate of the experimental group was 9.52%, which was lower than 22.22% of the control group, but the difference was not statistically significant (P>0.05). On the 1st day after injury, the proportions of CD3 and CD4 cells in the experimental group were lower than those in the control group, while the proportion of CD19 cells was higher than that in the control group (P < 0.05). The proportions of CD3 cells, CD4 cells and ratio of CD4 to CD8 of the control group on the 7th day after injury were lower than those on the 1st day after injury (P < 0.05). In the experimental group, the proportions of CD3, CD4 and CD8 cells increased on the 7th day after injury, while the proportion of NK and CD19 cells decreased (P < 0.05).
Immunosuppression occurs after severe trauma. The proportions of CD3 and CD4 cells in infected patients decrease significantly. Although thymopentin injection can′t significantly reduce the postoperative infection rate of patients with open lower limb fractures, it can increase the proportions of CD3 and CD4 cells, and effectively improve the immune function of patients after injury.
| [1] |
PAPE H C, WEBB L X. History of open wound and fracture treatment[J]. J Orthop Trauma, 2008, 22(10 suppl): S133-S134.
|
| [2] |
PAPAKOSTIDIS C, KANAKARIS N K, PRETEL J, et al. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification[J]. Injury, 2011, 42(12): 1408-1415. doi: 10.1016/j.injury.2011.10.015
|
| [3] |
陈聪, 毋凡, 覃茂鑫, 等. 严重创伤后免疫炎症反应机制及相关临床干预研究进展[J]. 中华创伤杂志, 2019, 35(10): 953-960.
|
| [4] |
BELSKY J B, RIVERS E P, FILBIN M R, et al. Thymosin beta 4 regulation of actin in Sepsis[J]. Expert Opin Biol Ther, 2018, 18(sup1): 193-197. doi: 10.1080/14712598.2018.1448381
|
| [5] |
王薇, 田蓉, 王真, 等. 胸腺五肽辅助比阿培南对老年重症肺炎患者肺功能及血清SP-A及SP-D水平的影响[J]. 中国老年学杂志, 2020, 40(18): 3874-3877. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202018023.htm
|
| [6] |
ZHOU J, MAO W J, KE L, et al. Thymosin alpha 1 in the prevention of pancreatic infection following acute necrotizing pancreatitis (TRACE trial): protocol of a multicentre, randomised, double-blind, placebo-controlled, parallel-group trial[J]. BMJ Open, 2020, 10(9): e037231. doi: 10.1136/bmjopen-2020-037231
|
| [7] |
LIU Y, PANG Y, HU Z, et al. Thymosin alpha 1 (Tα1) reduces the mortality of severe COVID-19 by restoration of lymphocytopenia and reversion of exhausted T cells[J]. Clin Infect Dis, 2020, 71(16): 2150-2157. doi: 10.1093/cid/ciaa630
|
| [8] |
GARNER M R, SETHURAMAN S A, SCHADE M A, et al. Antibiotic prophylaxis in open fractures: evidence, evolving issues, and recommendations[J]. J Am Acad Orthop Surg, 2020, 28(8): 309-315. doi: 10.5435/JAAOS-D-18-00193
|
| [9] |
HULL P D, JOHNSON S C, STEPHEN D J, et al. Delayed debridement of severe open fractures is associated with a higher rate of deep infection[J]. Bone Joint J, 2014, 96-B(3): 379-384. doi: 10.1302/0301-620X.96B3.32380
|
| [10] |
BLUM M L, ESSER M, RICHARDSON M, et al. Negative pressure wound therapy reduces deep infection rate in open tibial fractures[J]. J Orthop Trauma, 2012, 26(9): 499-505. doi: 10.1097/BOT.0b013e31824133e3
|
| [11] |
金国华, 赵胜春, 陈欣, 等. 开放性骨折患者术后伤口感染的细菌学特点及对抗菌药物的耐药性分析[J]. 中华医院感染学杂志, 2017, 27(6): 1321-1324. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201706033.htm
|
| [12] |
李筱轶, 秦瑾, 张虎波, 等. 开放性骨折术后伤口感染的危险因素分析[J]. 中华老年骨科与康复电子杂志, 2017, 3(2): 85-90. https://www.cnki.com.cn/Article/CJFDTOTAL-LNGK201702004.htm
|
| [13] |
中华医学会骨科学分会创伤骨科学组, 中华医学会骨科学分会外固定与肢体重建学组, 中国医师协会创伤外科医师分会创伤感染专业委员会, 等. 中国开放性骨折诊断与治疗指南(2019版)[J]. 中华创伤骨科杂志, 2019, 21(11): 921-928.
|
| [14] |
GOSSELIN R A, ROBERTS I, GILLESPIE W J. Antibiotics for preventing infection in open limb fractures[J]. Cochrane Database Syst Rev, 2004(1): CD003764.
|
| [15] |
胡居正, 石展英, 杨成志. T淋巴细胞亚群与四肢骨折感染的相关性研究[J]. 重庆医学, 2017, 46(29): 4153-4155. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201729039.htm
|
| [16] |
GRZALJA N, CICVARIC T, KNEZEVIC D, et al. Frequency and perforin expression of different lymphocyte subpopulations in patients with lower limb fracture and thoracic injury[J]. Injury, 2017, 48(Suppl 5): S1-S7.
|
| [17] |
姚晓聪. 不稳定骨盆骨折患者外周血T淋巴细胞亚群的动态变化及临床意义[J]. 中华危重症医学杂志: 电子版, 2013, 6(3): 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWZD201303009.htm
|
| [18] |
XIAO W, MINDRINOS M N, SEOK J, et al. A genomic storm in critically injured humans[J]. J Exp Med, 2011, 208(13): 2581-2590. doi: 10.1084/jem.20111354
|
| [19] |
WAGGONER S N, CORNBERG M, SELIN L K, et al. Natural killer cells act as rheostats modulating antiviral T cells[J]. Nature, 2011, 481(7381): 394-398.
|
| [20] |
XU K, MIAO L, CHEN W, et al. Establishment of the reference intervals of lymphocyte subsets for healthy Chinese Han adults and its influencing factors[J]. Ann Transl Med, 2021, 9(19): 1495. doi: 10.21037/atm-21-4031
|
| 1. |
马雪萍，王晓丽，阿里木江·司马义，徐桂萍. 腹股沟上髂筋膜阻滞复合全身麻醉对高龄髋关节置换患者术后谵妄发生的影响. 新疆医学. 2022(02): 131-134 .
| |
| 2. |
张宏，李淑萍. 老年患者髋关节置换术后谵妄的发生现状及其相关影响因素分析. 长春中医药大学学报. 2022(10): 1155-1159 .
| |
| 3. |
刘贵政，郑婷婷，杜斌. 老年髋部骨折患者术后谵妄发生现况及危险因素研究. 贵州医药. 2022(09): 1405-1406 .
| |
| 4. |
王秀环，鲍乐乐，马漪洁，陈宁宁. 不同麻醉方法对老年髋关节置换患者术后谵妄发生的影响. 广州医科大学学报. 2021(02): 40-44 .
| |
| 5. |
刘丹，杨万翔. 人文关怀护理对人工髋关节置换术后谵妄患者临床症状的影响. 中国当代医药. 2021(25): 270-272+276 .
| |
| 6. |
陈立红，徐芙蓉，叶洁玉，许华亮. 高龄骨科髋关节置换术后患者发生谵妄的危险因素分析. 现代医学与健康研究电子杂志. 2021(23): 115-118 .
| |
| 7. |
毛俊岚. 高龄患者髋关节置换术后谵妄1例的护理. 基层医学论坛. 2020(03): 420-421 .
| |
| 8. |
欧玉琼，吴建颖，周嫦娥. 以临床路径为指导的谵妄管理对老年股骨头置换术后患者的影响. 护理实践与研究. 2020(02): 86-88 .
| |
| 9. |
姜红卫. 骨科老年患者髋关节术后谵妄发生原因及疼痛干预护理进展. 系统医学. 2020(13): 196-198 .
|
© 2020 《实用临床医药杂志》编辑部
Address: 江苏省扬州市江阳中路136号，扬州大学江阳路北校区14号楼201室China Pos: 225009Tel: 0514-87978917、87978989、87978807
Supported by:
Beijing Renhe Information Technology Co., Ltd.
苏公网安备 32100302010246号
DownLoad: