摘要
目的探讨脓毒症患者外周血辅助性T细胞（THelper，Th）17及CD4^＋CD25^＋调节性T细胞（Treg细胞）表达的变化和检测的临床意义。方法将2008—01—2010—11在我医院ICU住院的脓毒症患者40例按照疾病严重程度分为三组：脓毒症组14例、严重脓毒症组15例和脓毒症休克组11例。再将脓毒症患者根据28d预后分为死亡组（D，n＝11）和存活组（S．n=29）。所有人选的40例脓毒症患者在入选当天行流式细胞术检测血中Thl7细胞及CD4^＋CD25^＋调节性T细胞的比例。比较脓毒症组、严重脓毒症组和脓毒症休克组患者血中Thl7细胞及CD4^＋CD25^＋调节性T细胞的比例变化，以及生存组和死亡组上述指标的差异。分析CD4^＋CD25^＋调节性T细胞和Thl7细胞免疫平衡紊乱与病情严重程度的关系。同时选取20例健康人为对照组。结果健康对照组Thl7细胞表达率为（0．91±0．38）％，CD4^＋CD25^＋调节性T细胞表达率为（0．39±0．23）％；脓毒症患者较正常对照组这两项指标明显升高，差异有统计学意义（P〈0．05）。其中脓毒症组分别为（2．09±0．53）％和（1．72±0．59）％；严重脓毒症组为（3．90±0．80）％和（2．72±0．22）％；脓毒性休克组为（1．85±0．35）％和（3.55±0．51）％。Thl7表达率严重脓毒症组最高，与其他两组比较差异有统计学意义（P〈0．05）。而脓毒症休克组与脓毒症组比较差异无统计学意义（P〉0．05）。CD4^＋CD25^＋调节性T细胞表达率脓毒症休克组最高，严重脓毒症组次之，脓毒症组最低，三组间两两比较差异有统计学意义（P〈0．05）。死亡组血中CD4^＋CD25^＋调节性T细胞表达率明显高于存活组[（3．03±0．91）％和（2．43±0．79）％，P〈0．05]，Thl7细胞表达率明显低于存活组[（2．01±0．66）％和（2．97±1．15）％，P〈0．05]。结论Thl7细胞和CD4^＋CD25^＋调节性T细胞在脓毒症的免疫发病机制中可能起着重要作用。检测脓毒症患者外周血．thl7细胞和CD4^＋CD25^＋调节性T细胞能够反映机体的细胞免疫状态，对评估患者预后有重要临床价值。
Objective To study the level and significance of Thl 7 calls and CD4^ ＋ CD25^＋ Treg ceils in peripheral blood of patients with sepsis. Methods Forty patients with sepsis in ICU of Anhui provincial hospital were studied from Jan 2008 to Nov 2010. Patients were divided into three groups： sepsis group（ n = 14）, severe sepsis group（ n = 15）, and septic shock group（ n = 11 ）. According to 28 - day prognosis, the patients with sepsis were divided into two groups ： death group （ n = 11 ） and survival group（n =29）. The expression of Thl7 cells and CD4^ ＋ CD25^＋ Treg cells of 40 patients on the I st day was detected by flow cytometry. The expression of Thl7 cells and CD4^ ＋ CD25^＋ Treg cells among the groups were compared and the correlation between the balance of CD4^ ＋ CD25^＋ Treg cells/Thl7 cells and the severity of sepsis was studied. Twenty healthy individuals were served as control. Results The expression rate of Thl7 cells was （0. 91 ± 0. 38 ）%, （2.09 ±0. 53 ）%, （3.90± 0. 80）% and （1.85 ± 0. 35） %, while the expression rate of CD4^ ＋ CD25^＋ Treg cells was （ 0. 39 ± 0. 23 ） % , （ 1.72 ± 0. 59）%, （2. 72 ±0. 22）% and（3.55±0. 51 ）% in control, sepsis, severe sepsis and septic shock group respectively. The expression rate of Thl7 cells was the highest in severe sepsis group（P 〈 0. 05 ）, but there was no significant difference between septic shock and sepsis group（P 〉 0. 05 ）. Moreover, the expression of CD4^ ＋ CD25^＋ Treg cells was the highest in septic shock group, followed by the severe sepsis group, and was the lowest in the sepsis group （ P 〈 0. 05 ）. The expression of CD4^ ＋ CD25^＋ Treg was obviously higher in death group than in survival group[ （ 3.03 ±0. 91 ） % vs（ 2.43 ± 0. 79 ） % ,P 〈 0.05 ], and Thl7 was significantly lower in the death group than in the survival group[ （2. 01±0.66） % vs（2.97 ±1.15） % , P〈0.05]. Conclusion The expression of Thl7 cells and CD4^ ＋ CD25^＋ Treg cells are increased in sepsis patients, which suggests that they may play an important role in pathogenesis of sepsis. The level of CD4^ ＋ CD25^＋ Treg and Thl7 can reflect the cell immune state of patients with sepsis and to detect these parameters was the clinical value in the evaluation of prognosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2011年第7期594-598,共5页
Chinese Journal of Critical Care Medicine
基金
基金项目：安徽省卫生厅课题（No.09A079）
