胸腺肽α1通过免疫调节减轻重症急性胰腺炎患者的炎症并预防感染：一项系统评价和荟萃分析

Thymosin alpha 1 alleviates inflammation and prevents infection in patients with severe acute pancreatitis through immune regulation: a systematic review and meta-analysis.

作者信息

Tian Yong, Yao Jiaqi, Ma Yihan, Zhang Pengcheng, Zhou Xiaofang, Xie Wenjie, Tang Wenfu

机构信息

Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Department of Gastroenterology and Hepatology, Chengdu First People's Hospital, Chengdu, Sichuan, China.

出版信息

Front Immunol. 2025 Jun 17;16:1571456. doi: 10.3389/fimmu.2025.1571456. eCollection 2025.

DOI:10.3389/fimmu.2025.1571456

PMID:40599771

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12208829/

Abstract

BACKGROUND

Immune and inflammatory disorders are part of the complex pathophysiological processes that exacerbate severe acute pancreatitis (SAP) and subsequent infection. Thymosin alpha 1 (Tα1) is an important immunomodulatory agent in clinical practice, but there is a lack evidence to prove its effectiveness in improving the condition of SAP patients. In this study, we aimed to evaluate the efficacy in meta-analysis.

METHODS

We systematically searched PubMed, Embase, Web of Science, Cochrane Library and China National Knowledge Infrastructure (CNKI) up to February 1, 2025. Randomized controlled studies comparing the efficacy of Tα1 as intervention measure with non-Tα1 in improving immune regulation for patients with SAP were included. Review Manager 5.3 was used to assess endpoints in the meta-analysis.

RESULTS

Five randomized controlled trials comprising 706 patients with SAP were included. The results indicated that Tα1 could increase the percentages of CD4 cells (MD=4.53, 95%CI [3.02, 6.04], P<0.00001) and improve the CD4/CD8 ratio (MD=0.42, 95%CI [0.26, 0.58], P<0.00001) in SAP patients. There was no statistically significant decrease in CD8 cells. For inflammation, lower-dose Tα1 could significantly reduce C-reactive protein (CRP) levels (mg/L) (MD=-30.12, 95%CI [-35.75, -24.49], P<0.00001), while higher-dose Tα1 showed no statistically significant difference (MD=-3.83, 95%CI [-12.14, 4.49], P=0.37). In terms of infection, the immunomodulatory therapy of Tα1 obviously reduced the overall incidence of extrapancreatic infections in SAP patients (RR=0.56, 95%CI [0.40, 0.78], P=0.0005), especially for blood (RR=0.60, 95%CI [0.38, 0.94], P=0.03) and abdominal (RR=0.38, 95%CI [0.19, 0.78], P<0.0001), while the reduction in lung infections was not statistically significant. Regarding hospital stay (days), Tα1 did not significantly reduce the time spent (MD=-4.22, 95%CI [-11.53, 3.10], P=0.26). However, Tα1 reduced the APACHE II score (MD=-1.52, 95%CI [-2.22, -0.83], P<0.0001).

CONCLUSION

Tα1 can regulate the balance of immune cells and alleviate immune suppression in SAP patients, including increasing CD4 T cells and CD4/CD8 ratios. Tα1 may exert anti-inflammatory and extrapancreatic infection-preventive effects on SAP patients and improve their condition or prognosis. More researches are needed to validate the results.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero, identifier CRD42024570517.

摘要

背景

免疫和炎症紊乱是加重重症急性胰腺炎（SAP）及后续感染的复杂病理生理过程的一部分。胸腺肽α1（Tα1）是临床实践中一种重要的免疫调节剂，但缺乏证据证明其对改善SAP患者病情有效。在本研究中，我们旨在通过荟萃分析评估其疗效。

方法

我们系统检索了截至2025年2月1日的PubMed、Embase、Web of Science、Cochrane图书馆和中国知网（CNKI）。纳入比较Tα1作为干预措施与非Tα1在改善SAP患者免疫调节方面疗效的随机对照研究。使用Review Manager 5.3对荟萃分析中的终点进行评估。

结果

纳入了5项随机对照试验，共706例SAP患者。结果表明，Tα1可提高SAP患者CD4细胞百分比（MD = 4.53，95%CI [3.02, 6.04]，P < 0.00001），并改善CD4/CD8比值（MD = 0.42，95%CI [0.26, 0.58]，P < 0.00001）。CD8细胞无统计学意义的减少。对于炎症，低剂量Tα1可显著降低C反应蛋白（CRP）水平（mg/L）（MD = -30.12，95%CI [-35.75, -24.49]，P < 0.00001），而高剂量Tα1无统计学意义（MD = -3.83，95%CI [-12.14, 4.49]，P = 0.37）。在感染方面，Tα1的免疫调节治疗明显降低了SAP患者胰腺外感染的总体发生率（RR = 0.56，95%CI [0.40, 0.78]，P = 0.0005），尤其是血液感染（RR = 0.60，95%CI [0.38, 0.94]，P = 0.03）和腹腔感染（RR = 0.38，95%CI [0.19, 0.78]，P < 0.0001），而肺部感染的降低无统计学意义。关于住院天数，Tα1未显著缩短住院时间（MD = -4.22，95%CI [-11.53, 3.10]，P = 0.26）。然而，Tα1降低了急性生理与慢性健康状况评分系统II（APACHE II）评分（MD = -1.52，95%CI [-2.22, -0.83]，P < 0.0001）。