摘要 目的 观察氢化可的松对感染性休克患者炎症因子和miRNA-122a的影响。 方法 选取2016年12月至2018年12月沧州市中心医院急诊重症监护室(EICU)收治的125例感染性休克患者为研究对象，随机法分为常规治疗组65例，氢化可的松组60例。常规治疗组给予常规综合治疗，氢化可的松组在常规治疗基础上给予氢化可的松200 mg/d，持续静脉给药，疗程7 d。分别在治疗前和治疗后3、7 d应用酶联免疫吸附试验(ELISA)测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、高迁移率族蛋白B-1 (HMGB-1)的水平，定量即时聚合酶链锁反应(qRT-PCR)法检测血清miRNA-122a的表达水平；对比两组患者APACHE Ⅱ评分、SOFA评分、肝功能、血管活性药物使用时间、EICU治疗时间及28 d病死率。 结果 治疗前，两组患者血清TNF-α、IL-6、HMGB-1、miRNA-122a差异无统计学意义(P>0.05)。氢化可的松组各指标均低于常规治疗组［TNF-α（pg/mL）：治疗后3 d 146.29±19.34 vs. 165.26±16.45，治疗后7 d 118.63±20.48 vs. 125.83±16.87；IL-6（pg/mL）：治疗后3 d 150.73±15.36 vs. 237.62±18.45，治疗后7 d 124.35±16.28 vs. 149.94±19.64；HMGB-1（ng/mL）：治疗后3 d 7.78±1.06 vs. 11.72±1.25，治疗后7 d 2.49±0.50 vs. 3.87±0.64；miRNA-122a：治疗后3 d 1.42±0.46 vs. 1.95±0.37，治疗后7 d 0.86±0.15 vs. 1.18±0.29；P<0.01］。与常规治疗组比较氢化可的松组患者肝功能明显好转［ALT（U/L）：治疗后3 d 77(120.3) vs. 72.8(112.4)，治疗后7 d 69(28.2) vs. 62.5(20.9)；AST（U/L）：治疗后3 d 80.4(118.5) vs. 76.7(105.8)，治疗后7 d 73.6(29.7) vs. 65.9(26.7)；TBIL（mg/dL）：治疗后3 d 1.7(3.4) vs. 1.6(2.7)，治疗后7 d 1.5(0.9) vs. 1.4(0.8)；P<0.01］。EICU治疗时间明显缩短（d：15.4±6.5 vs. 10.7±5.3），差异有统计学意义(P<0.05)，但28 d病死率未见降低(P>0.05)。 结论 氢化可的松可明显降低感染性休克患者血清中miRNA-122a的表达水平，降低炎症因子水平，减轻肝脏损伤，缩短EICU治疗时间，但并不能降低感染性休克患者的28 d病死率。
桑珍珍，高杰，贾春梅，李勇. 氢化可的松对感染性休克患者miRNA-122a和炎症因子的影响[J]. 中国急救医学, 2019, 39(9): 845-849.
Sang Zhen-zhen, Gao Jie, Jia Chun-mei, Li Yong. Effect of glucocorticoid on inflammatory cytokines and miRNA-122a in septic shock. Chinese Journal of Critical Care Medicine, 2019, 39(9): 845-849.
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