Study Of Immunoregulation Therapy Using Arginine In Sepsis

Sepsis is an excessive systemic inflammatory response syndrome (SIRS) induced byinfection. It may lead to septic shock, multiple organ dysfunction syndrome (MODS). Itis one of the most important cause of death in critically ill patients. Immune dysfunctionis a very important part of the pathophysiology in sepsis development process. Serve asa conditionally essential amino acid, arginine is widely involved in cell metabolism,immune regulation, protein metabolism, hormone secretion, circulation regulation,wound healing and maintenance of intestinal mucosal barrier function. The argininelevel of tissue and blood in patients with sepsis is lower, compared with that in thehealthy people and non-septic patients. It plays a key role that inflammatory mediatorsinfluence on arginine metabolism. It is feasible theoretically, that exogenous arginine issupplemented to improve arginine deficiency of patient body, in order to improvingimmune function of the patients with sepsis. This study is that the exogenous arginine isused as an immune regulation in the patients with sepsis, to explore the value ofarginine in immunomodulation therapy.ObjectiveTo study the effect of arginine on immunoregulation in the patients with sepsis, todiscuss the value of arginine in clinical application.MethodsFrom July2012to December2013,62patients with sepsis were chosen in ICU ofthe Southern District of Anhui Provincial Hospital. They were divided into thetreatment group (n=32) and control group (n=30) randomly. The patients in two groups were diagnosed with sepsis, they were treated in accordance with “Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2008”, The patientsin the treatment group were treated by arginine15g/d on the basis of conventionaltherapy. The arginine was diluted with5%glucose solution500ml, and givenintravenous infusion slowly once a day,7days continuously. The T cell subsets,immunoglobulin and the expressive rate of human leukocyte antigen-DR (HLA-DR)/cluster of differentiation14(CD14+) monocyte were assayed in the first day those andthe seventh day in all patients with sepsis, and record the patients’ the blood routine,biochemistry, C-reactive protein (CRP), blood gas analysis and28d mortality.SPSS13.0software was used for statistical analysis. The paired T test was used withinthe group. The independent sample T test was used between the two groups. Chi-squaretest was used in comparing the rates. The linear correlation was used in correlationanalysis.ResultsThe expressive rate of HLA-DR/CD14+monocyte and IgG were higher in thetreatment group than that in the control group after treatment (P<0.05,0.01). IgA andIgM were no significant increase (P>0.05), T cell subsets were no significant difference(P>0.05),28d mortality was no significant difference, between the patients in the twogroups (P>0.05).Conclusion1. The expression rate of HLA-DR/CD14+monocyte appeared to reduce in the earlystage of sepsis. The patient with sepsis was in the state of immune suppression.2. Arginine could increase the expression rate of HLA-DR/CD14+monocyte in thepatients with sepsis, and it may improve patients’ state of immune suppression.3. Arginine may enhance non-specific humoral immune function in the patients withsepsis, and increase the level of IgG. 4. Arginine plays an active role in the course of treating sepsis, it may be used as a partof comprehensive treatment of sepsis.