脓毒症患者自然调节性T细胞及可溶性CD25水平研究  

The study on the expressions of circulatory CD4^ ＋ CD25^ ＋ Foxp3^ ＋ regulatory T cells and the plasma levels of soluble CD25 in septic patients

作　　者：冷凤英[1] 刘嘉琳[1] 瞿洪平[1] 

机构地区：[1]上海交通大学附属瑞金医院RICU,上海200025

出　　处：《中华急诊医学杂志》2011年第2期184-188,共5页Chinese Journal of Emergency Medicine

摘　　要：目的 通过前瞻性研究探讨脓毒症患者外周血自然调节性T细胞（Treg）百分比和血浆可溶性CD25分子（IL-2sRa）水平的变化及其临床价值.方法 将2009年2月至2010年2月上海交通大学附属瑞金医院重症医学科所收治的符合ACCP/SCCM于1997年提出的SIRS与脓毒症诊断标准的37例脓毒症患者与15例非感染SIRS患者,以及上海交通大学附属瑞金医院体检中心24例排除感染及免疫系统基础疾病患者,根据诊断标准分为脓毒症组、非感染SIRS组与正常对照组.其中脓毒症组男性26例,女性11例,年龄（61.67±11.87）岁;非感染SIRS组男性8例,女性7例,年龄（67.06±12.57）岁;正常对照组男14例,女10例,年龄（56.54±6.37）岁.脓毒症组肺部感染28例,腹腔感染6例,其他4例;非感染SIRS组为择期清洁手术后24 h内无感染征象者.所有入选对象均排除免疫系统基础疾病和（或）近期（30 d内）曾使用或正在使用强效免疫抑制剂患者.流式细胞分析术检测三组外周血Treg细胞百分比,ELISA检测血浆IL-2sRa,IL-4,IFN-γ水平.所得数据采用方差分析及非参数检验的Kruskal-Wallis H方法.结果 ①Treg细胞在脓毒症组、SIRS组和正常对照组占外周血CD4＋CD25＋T细胞的比例分别为：（66.82±21.79）%,（51.79±21.79）%、（56.45±10.68）%,脓毒症组Treg细胞显著高于SIRS组和正常对照组（P=0.001）.②与SIRS组（381.664±189.83）和对照组（164.132±56.37）相比,脓毒症组可溶性CD25分子（IL-2sRa）水平（425.619±270.12）显著增高（P=0.000）.③IL-2sRa浓度与Treg细胞占CD4＋CD25＋T细胞的比例相关分析示：Spearman相关系数=0.390,P=0.003（P＜0.05）,两者存在正相关关系.结论 Treg细胞在脓毒症患者外周血的表达水平特征性增高.而外周血IL-2sRa水平可以反映Treg细胞表达水平,也有助于简化判断脓毒症的免疫状态的方法.Objective To explore the CD4 ＋ CD25 ＋ Foxp3 ＋ regulatory T cell percentage and plasma levels of soluble CD25 molecules in peripheral blood of septic patients and their clinical value through prospective study. Method A total of 37 septic patients and 15 non-infectious SIRS patients, who conformed to the criteria of SIRS and sepsis which proposed by American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference （ ACCP/SCCM ） in 1997, were collected in ICU of Ruijin Hospital （ Shanghai Jiaotong University） from February 2009 to February 2010. Twenty-four health people were from Medical Center of Ruijin Hospital, who were excluded infection and （or） autoimmune diseases. There were 26 male and 11 female in sepsis group, average age （ 61.67 ± 11.87 ） years old; 8 male and 7 female in SIRS group, average age （67.06 ± 12.57）years old; 14 male and 10 female in health control, average age （56.54 ± 6.37 ）years old. All selected patrents were excluded the autoimmune diseases and （or） patients within recent （30 days） had used or now used immunosuppressive agents. We therefore measured the Treg cell percentage in peripheral blood by Flow Cytometry and the plasma levels of IL-2sRa, IL-4, IFN-γ by ELISA. The data were analyzed by analysis of variance or nonparametric Kruskal-Wallis H test. Results ① The percentage of CD4 ＋ CD25 ＋ Foxp3 ＋ regulatory T cells among septic patients, SIRS patients, and control group was： （ 66.82 ± 21.79 ） %, （ 51.79 ± 21.79 ） %, （ 56.45 ± 10. 68 ） %, respectively. septic patients showed the highest percentages of CD4 ＋ CD25 ＋ Foxp3 ＋ regulatory T cell among CD4 ＋ CD25 ＋ T cells（P 〈 0.05 ）. ② The plasma levels of soluble CD25 in septic patients （425. 619 ± 270.12 ） were significantly higher than SIRS patients （381. 664 ± 189.83） and the control group （ 164. 1 32 ± 56.37 ） （ P 〈 0.05 ）. ③ The correlation analysis between the concentration of soluble CD25 molecules in

关 键 词：脓毒症 SIRS TREG细胞 Foxp3 白介素-2sRa 干拢素-γ 白介素4 干拢素-γ/白介素-4 

分 类 号：R459.7[医药卫生—急诊医学]