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目的:观察重症监护室(ICU)内早期败血症患者体内的免疫T细胞变化。方法:研究对2012年6月—2013年12月间我院ICU内收治的37例早期败血症患者,15例非感染性全身炎症反应患者(SIRS)及24名健康对照。检验了试验对象血液中Tregs细胞的比例、血浆中干扰素-γ(IFN-γ)、白介素-4(IL-4)及可溶性CD25的水平。结果:与对照组相比,早期脓毒败血症患者血浆IFN-γ和IL-4明显升高,分别为66.10(45.23~85.08)pg/m L、20.97(17.58~26.21)pg/m L和100.69(77.41~127.68)pg/m L、70.40(64.14~80.15)pg/m L(P<0.001),同时IFN-/IL-4比值[0.66(0.62~0.67)vs 0.30(0.27~0.33),P<0.001]也明显上升,败血症患者和SIRS患者上述指标没有差异(P>0.05)。早期败血症患者体内CD4+、CD25+、Foxp3+调节性T细胞比例明显高于SIRS和健康对照[(66.82%±21.79%)vs(51.79%±21.79%)vs(56.45%±10.68%),P=0.003],利用这一指标能将早期败血症和SRIS区分出来。早期败血症患者血浆可溶性CD25水平也显著提高,并且其水平与Tregs细胞的比例呈正相关(Spearman相关系数=0.390,P=0.003)。结论:结果提示CD4+、CD25+、Foxp3+调节性T细胞可以作为脓毒败血症的早期诊断指标并以此将此类患者与非感染的全身炎症反应患者区分开来。其比例还可用于评估患者的免疫状况并帮助医生制定最佳免疫调节治疗方案。
Objective: To observe the changes of immune T cells in patients with early sepsis in intensive care unit (ICU). Methods: Thirty-seven patients with early sepsis, 15 patients with noninfectious systemic inflammatory response (SIRS) and 24 healthy controls were enrolled in our hospital from June 2012 to December 2013. The proportion of Tregs cells in blood, the levels of interferon-γ (IFN-γ), interleukin-4 (IL-4) and soluble CD25 in plasma were examined. Results: Compared with the control group, the plasma levels of IFN-γ and IL-4 were significantly increased in patients with early sepsis, which were 66.10 (45.23-85.08) pg / m L, 20.97 (17.58-26.21) pg / m L and 100.69 (P <0.001), while the IFN- / IL-4 ratio [0.66 (0.62-0.67) vs 0.30 (0.27-0.33) P <0.001]. There was no difference in the above indexes between sepsis patients and SIRS patients (P> 0.05). The proportion of CD4 +, CD25 + and Foxp3 + regulatory T cells in patients with early sepsis was significantly higher than that in SIRS and healthy controls [(66.82% ± 21.79%) vs (51.79% ± 21.79% vs 56.45% ± 10.68%, P = 0.003] , Use of this indicator can distinguish between early sepsis and SRIS out. Serum soluble CD25 level was also significantly increased in patients with early sepsis and its level was positively correlated with the proportion of Tregs cells (Spearman correlation coefficient = 0.390, P = 0.003). CONCLUSIONS: The results suggest that CD4 +, CD25 +, Foxp3 + regulatory T cells may be used as an early diagnostic marker for sepsis and to distinguish such patients from noninfectious systemic inflammatory response patients. The ratio can also be used to assess the patient’s immune status and help doctors develop the best immunomodulatory regimen.