摘要
目的探讨脓毒症患者血清白细胞介素-35(interleukin-35,IL-35)水平与CD4^+T细胞的表达及相互调控的关系。方法选取2017年1月-2018年1月就诊安庆市立医院重症医学科外科重症监护室(Intensive Care Unit,ICU)的脓毒症患者50例,按"脓毒症3.0"定义分成一般脓毒症组及脓毒症休克组,同期随机选择于医院体检中心进行健康体检的志愿者50名,设置为对照组,分别完善患者进入ICU后0 h、6 h、2 d及5 d的序贯器官衰竭评分(Sequential organ failure score,SOFA),并检测其外周血IL-35的水平、计算CD4^+T细胞的阳性率及早期凋亡率。结果随着治疗时间的延长,一般脓毒症组与脓毒症休克组的SOFA评分、外周血IL-35水平、外周血CD4^+T细胞阳性率及外周血CD4^+T细胞早期凋亡率基本呈下降趋势(均P<0.001)。两组2 d及5 d与0 h的SOFA评分[(4.63±1.31)分、(2.50±0.87)分vs(7.13±2.34)分;(19.00±4.66)分、(15.07±6.17)分vs(20.20±2.67)分]和CD4^+T细胞阳性率[(36.13±3.92)%、(33.61±5.68)%vs(48.83±7.47)%;(57.53±7.26)%、(46.58±7.14)%vs(65.74±11.45)%]比较差异有统计学意义(P<0.05);两组6 h、2 d及5 d与0 h的外周血IL-35的水平比较[(59.22±8.92)ng/L、(48.37±8.14)ng/L、(41.75±9.20)ng/L vs(64.05±9.62)ng/L;(80.02±12.19)ng/L、(63.24±11.91)ng/L、(52.05±11.55)ng/L vs(76.84±8.87)ng/L]差异有统计学意义(P<0.05),两组2 d及5 d与6 h外周血CD4^+T细胞早期凋亡率[(4.60±0.70)%、(4.52±1.48)%vs(4.97±1.11)%;(7.16±1.35)%、(6.62±1.44)%vs(8.42±1.62)%]比较的差异有统计学意义(P<0.05)。脓毒症休克组各时间点的SOFA评分、外周血IL-35水平、外周血CD4^+T细胞阳性率及外周血CD4^+T细胞早期凋亡率高于一般脓毒症组(P<0.05)。结论CD4^+T细胞促进IL-35的分泌,IL-35可作为早期诊断脓毒症及判断病情严重程度的指标,高浓度的IL-35可诱导CD4^+T细胞的早期凋亡。
OBJECTIVE To investigate the level of serum interleukin-35(IL-35),the expression of CD4^+T cells,and the mutual regulation of these two in patients with sepsis.METHODS 50 patients with sepsis who were admitted to the Intensive Care Unit(ICU)in Department of Critical Care Medicine Surgery of Anqing Municipal Hospital from Jan.2017 to Jan.2018 were selected,and divided into general sepsis group and sepsis shock group according to the definition of sepsis 3.0.During the same period,50 volunteers who came for physical examination at our physical examination center were randomly selected as the control group.At 0 h,6 h,2 d,and 5 d after the patients entered the ICU,the scores of Sequential Organ Failure Assessment(SOFA)and the peripheral blood IL-35 levels were measured,and the positive rate and early apoptosis rate of CD4^+T cells were calculated.RESULTS With the prolongation of treatment time,SOFA score,IL-35 level in peripheral blood,CD4^+T cell positive rate in peripheral blood and early apoptosis rate of CD4+T cells in peripheral blood of the general sepsis group and the septic shock group all significantly decreased(all P<0.001).There were significant differences in SOFA score[(4.63±1.31),(2.50±0.87)vs(7.13±2.34);(19.00±4.66),(15.07±6.17)vs(20.20±2.67)]and CD4^+T cell positive rate[(36.13±3.92)%,(33.61±5.68)%vs(48.83±7.47)%;(57.53±7.26)%,(46.58±7.14)%vs(65.74±11.45)%]between the two groups at 2 d,5 d compared with 0 h(P<0.05);the levels of IL-35 in peripheral blood at 6 h,2 d,5 d compared with 0 h[(59.22±8.92)ng/L,(48.37±8.14)ng/L,(41.75±9.20)ng/L vs(64.05±9.62)ng/L;(80.02±12.19)ng/L,(63.24±11.91)ng/L,(52.05±11.55)ng/L vs(76.84±8.87)ng/L]in the two groups were significantly different(P<0.05);the early apoptotic rate of CD4+T cells in peripheral blood at 2 d,5 d compared with 6 h[(4.60±0.70)%,(4.52±1.48)%vs(4.97±1.11)%;(7.16±1.35)%,(6.62±1.44)%vs(8.42±1.62)%]in the two groups was significantly different(P<0.05).The SOFA score,IL-35 level in peripheral blood,positive rate of CD4^+T cells in peripheral blood and early apoptotic rate of CD4^+T cells in peripheral blood in the septic shock group were significantly higher than those in the general sepsis group at each time point(P<0.05).CONCLUSION CD4^+T cells promote the secretion of IL-35,and IL-35 can be used as an indicator for early diagnosis of sepsis and for assessment of the severity of sepsis.High concentrations of IL-35 can induce early apoptosis of CD4^+T cells.
作者
程储记
方长太
汪文婧
马玉仓
CHENG Chu-ji;FANG Chang-tai;WANG Wen-jing;MA Yu-cang(Anqing Municipal Hospital,Anqing,Anhui 246003,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第15期2265-2269,2279,共6页
Chinese Journal of Nosocomiology
基金
安徽省公益性技术应用研究联动计划基金资助项目(1704f0804036)
