脉冲高容量血液滤过对脓毒症患者CD4^+CD25^+调节性T细胞的影响  

Effect of pulse high volume hemofiltration on CD4^+CD25^+ Treg cells in patients with sepsis

作　　者：邵敏[1] 刘宝[1] 王锦权[1] 陶晓根[1] 周树生[1] 金魁[1] 张翠萍[2] 

机构地区：[1]安徽省立医院ICU [2]安徽省立医院中心实验室,安徽合肥230001

出　　处：《中日友好医院学报》2011年第2期87-91,共5页Journal of China-Japan Friendship Hospital

基　　金：安徽省卫生厅课题(09A079)

摘　　要：目的:探讨脓毒症患者CD4+CD25+调节性T细胞(Treg)的水平和意义以及脉冲高容量血液滤过(PHVHF)对它们的影响。方法:将2008年1月~2010年11月在安徽省立医院ICU住院的脓毒症患者40例按照疾病严重程度分为3组:脓毒症组14例,严重脓毒症组15例,脓毒症休克组11例。其中行PHVHF患者25例。40例脓毒症患者在入选当天和d5行流式细胞术检测血中CD4+CD25+Treg细胞的比例和CD3+、CD4+、CD8+和CD4+/CD8+水平。同时选取20例健康人为对照组。结果:健康对照组CD4+CD25+Treg细胞表达率为(0.39±0.23%);脓毒症组为(1.72±0.59%);严重脓毒症组(2.72±0.22%);脓毒性休克组(3.55±0.51%),后3组间两两比较有显著性差异(均P<0.05)。脓毒症组CD3+、CD4+和CD4+/CD8+较正常对照组显著升高(P<0.05)。严重脓毒症组和脓毒症休克患者CD3+、CD4+、CD4+/CD8+较正常对照组显著降低(均P<0.05)。与死亡组比较,生存组PHVHF能更有效地降低CD4+CD25+Treg细胞的异常表达(P<0.05),上调CD3+、CD4+、CD8+和CD4+/CD8+水平。结论:CD4+CD25+Treg细胞在脓毒症的免疫发病机制中可能起着重要作用,随病情加重,免疫抑制加强。PHVHF可调整脓毒症患者T细胞亚群比例,改善其免疫抑制状态,可作为脓毒症免疫调节治疗的手段之一。Objective：To study the level and significance of CD4^＋CD25＋ Treg cells and CD3^＋,CD4^＋,CD^8＋ cells in peripheral blood of patients with sepsis and evaluate the effects of pulse high volume hemofiltration（PHVHF）on them.Methods：Forty patients with sepsis in ICU of Anhui Provicial Hospital were studied from January 2008 to November 2010.Patients were divided into three groups：sepsis group（n=14）,severe sepsis group（n=15）and septic shock group（n=11）.The expressions of CD4^＋CD25＋ Treg cells and CD3^＋,CD4^＋,CD^8＋ cells of 40 patients on the day 1 and day 5 were detected by flow cytometry and were compared.Twenty five patients receiving PHVHF were divided into two groups：death group（n=7）and survive group（n=18）.Twenty healthy individuals served as controls.Results：The expressions of CD4^＋CD25＋ Treg cells were the highest in septic shock group（3.55±0.51%）,followed by the severe sepsis group（2.72±0.22%） and the sepsis group（1.72±0.59%）.There were significant differences among the three groups（all P〈0.05）.The level of CD3^＋,CD4^＋ and CD4^＋/CD^8＋ in sepsis group was higher than control group（P〈0.05）and the level of CD3^＋、CD4^＋ and CD4^＋/CD^8＋ in severe sepsis and sepsis shock were lower than control group（P〈0.05）.Compared with death group,PHVHF could decrease the abnormal expression of CD4^＋CD25＋ Treg cells and increase the level of CD3^＋,CD4^＋ and CD4^＋/CD^8＋ in survive group.Conclusion：CD4^＋CD25＋ Treg cells may play an important role in pathogenesis of sepsis.PHVHF could rebuild immunologic balance and to be used in the treatment of sepsis patients.

关 键 词：脓毒症 免疫平衡 CD4+CD25+调节性T细胞 脉冲高容量血液滤过 

分 类 号：R459.7[医药卫生—急诊医学]