Impact of norepinephrine combined with terlipressin on myocardial injury and immune function in patients with septic shock
Fang Ping
Li Li
Weng Xuan
Zheng Yan
Abstract：Objective To investigate the therapeutic effects of norepinephrine(NE)combined with terlipressin(TP)on myocardial injury in patients with septic shock and the impact on CD4+CD25+regulatory T cells.Methods A total of 106 pa-tients with septic shock admitted to the Second People's Hospital of Neijiang from August 2021 to August 2024 were enrolled and randomly divided into two groups:the NE group and the NE/TP group,with 53 cases in each group.Both groups received conventional treatment.The NE group was treated with NE alone,while the NE/TP group was treated with a combination of NE and TP.The hemodynamic parameters(heart rate,mean arterial pressure and oxygen saturation)and NE dosage before treatment and after treatment for 6,12,and 24 hours,myocardial injury markers(troponin and creatine kinase isoenzyme)before and after treatment,regulatory T cell levels(CD4+,CD4+CD25+),and disease severity(sequential organ failure assessment(SOFA)score,and acute physiology and chronic health evaluation(APACHE)score)were compared between the two groups.Results The heart rate decreased over time in both groups,while the mean arterial pressure and oxygen saturation increased.The NE/TP group had lower heart rates after treatment for 6,12,and 24 hours(Fbetween/Pbetween=61.860/<0.001,Ftime/Ptime=769.600/<0.001,Finteraction/Pinteraction=12.570/<0.001),higher mean arterial pressure after treatment for 12 and 24 hours(Fbetween/Pbetween=19.880/<0.001,Ftime/Ptime=247.600/<0.001,Finteraction/Pinteraction=4.019/0.008),and higher oxygen saturation after treatment for 6,12,and 24 hours(Fbetween/Pbetween=77.860/<0.001,Ftime/Ptime=142.200/<0.001,Finteraction/Pinteraction=10.760/<0.001)than the NE group.There were sig-nificant differences between the two groups(all P<0.05).The NE dosage in the NE/TP group((0.45±0.10)μg·kg-1·min-1,(0.24±0.07)μg·kg-1·min-1,(0.13±0.03)μg·kg-1·min-1,(0.06±0.02)μg·kg-1·min-1)was lower than in the NE group((0.61±0.14)μg·kg-1·min-1,(0.32±0.09)μg·kg-1·min-1,(0.18±0.05)μg·kg-1·min-1,(0.11±0.03)μg·kg-1·min-1)before treatment and after treatment for 6,12 and 24 hours(t=6.770,5.108,6.243,10.096,all P<0.001).After the treatment,the troponin level,creatine kinase isoenzyme level,CD4+level,CD4+CD25+level,SOFA score,and APACHE score decreased in both groups,with lower values in the NE/TP group((0.12±0.03)ng·mL-1,(24.62±3.28)U·L-1,(40.24±5.21)cells·μL-1,(0.42±0.12)%,(7.63±1.84)points,(19.38±4.04)points)than in the NE group((0.20±0.04)ng·mL-1,(29.71±3.58)U·L-1,(43.05±4.76)cells·μL-1,(0.60±0.17)%,(9.38±1.99)points,(25.04±5.32)points)(t=11.648,7.632,2.899,6.297,4.701,6.168,all P<0.001).Conclusion The combination of NE and TP is effective in treating sep-tic shock,stabilizing hemodynamics,alleviating myocardial injury,and restoring immune function.
Keywords：Septic shockTerlipressinNorepinephrineHemodynamicsRegulatory T cell
Publication Date：2025-08-25
Online Publishing Date：2025-09-01(First online date of this platform, not the publication date of the document)
Pages：4( 820-823 )