低剂量氢化可的松治疗感染性休克时对外周血T淋巴细胞凋亡的影响及机制  

Effect and mechanism of low dose hydrocortisone on circulating lymphocyte apoptosis in human septic shock

作　　者：李秀华[1] 陈永铭[1] 洪亮[1] 袁受涛[1] 郑曙云[1] 

机构地区：[1]南京医科大学附属南京第一医院ICU,江苏南京210006

出　　处：《南京医科大学学报（自然科学版）》2011年第5期730-735,共6页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的：探讨低剂量氢化可的松治疗感染性休克时对外周血T淋巴细胞凋亡的影响及机制。方法：前瞻性的将南京市第一医院ICU自2006年1月2009年1月收治的57例感染性休克患者按照随机对照的原则分为低剂量氢化可的松治疗组和对照组,同时选择20例健康志愿者和18例脓毒血症患者。采取外周血,用Annexin V法和流式细胞仪测定T淋巴细胞亚群的凋亡情况,用酶增敏免疫测定（EASIA）法测定血清中肿瘤坏死因子α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-10（IL-10）的浓度,观察低剂量氢化可的松对上述各项指标的影响。结果：在初始状态下,外周血CD4＋T淋巴细胞亚群的凋亡在健康对照组、脓毒血症组及感染性休克组分别为（4.41±1.45）%,（7.87±3.82）%及（11.01±4.52）%,感染性休克患者的外周血CD4＋T淋巴细胞亚群的凋亡多于脓毒血症患者（P〈0.05）,脓毒血症患者多于健康对照组（P〈0.05）;而初始状态下健康对照组、脓毒血症组及感染性休克组患者外周血T淋巴细胞CD8＋亚群的凋亡,3组比较差异无统计学意义（P〉0.05）。48 h后休克对照组和治疗组CD4＋亚群的凋亡分别为（19.39±6.63）%和（22.61±5.64）%,治疗组明显多于对照组（P〈0.05）;而48 h后CD8＋亚群的凋亡为在休克对照组和治疗组之间比较无统计学意义（P〉0.05）。在基础状态下TNF-α的浓度在健康对照组,脓毒血症组及感染性休克组中分别为（16.44±9.55）pg/mL,（29.58±13.6）pg/mL及（47.99±25.63）pg/mL,感染性休克组高于脓毒血症组（P〈0.05）,脓毒血症组高于健康对照组（P〈0.05）,持续72 h;起病48 h后感染性休克对照组和治疗组的TNF-α浓度分别为（73.47±25.39）pg/mL和（59.66±16.37）pg/mL,治疗组明显低于对照组（P〈0.05）;IL-1β在健康对照组、脓毒血症组及感染性休克组中分别为（13.12±5.07）pg/mL,（25.21±14.7）pg/mL及（22Objective：To investigate the effect and mechanism of hydrocortisone on circulating T lymphocyte apoptosis in human septic shock.Methods：Total 57 patients with septic shock from January 2006 to January 2009 in Intensive Care Unit of Nanjing First Hospital Affiliated to NJMU were prospectively randomized into treatment groups and control group.Low-dose hydrocortisone was used in treatment group but not in control group.Peripheral venous blood samples of the included patients were obtained to determine the circulating T lymphocyte apoptosis by Annexin V and flow cytometry.At the meantime,the plasma concentration of TNF-α,IL-1β and IL-10 were determined by EASIA.All these results were compared with 20 healthy volunteers and 18 pyemia patients.In the meantime,the difference of septic shock control group and hydrocortisone treatment group was analyzed to investigate the effect of low-dose hydrocortisone on these results.Results：In baseline,the apoptosis percentage of CD4＋T lymphocytes in healthy volunteers,pyemia patients and septic shock patients was（4.41±1.45）%,（7.87±3.82）% and（11.01±4.52）%,respectively.And the percentage of Annexin V-positive CD4＋ T lymphocytes was higher in septic shock patients than in pyemia patients（P 〈 0.05）,and the later was higher than healthy volunteers（P 〈 0.05）.At the same time,there was no difference in the apoptosis percentage of CD8＋ T lymphocytes among these groups（P 〉 0.05）.After treatment of 48 h,the apoptosis percentage of CD4＋ T lymphocytes was higher in hydrocortisone treatment group than that in control group,（P 〈 0.05）,while,the apoptosis percentage of CD8＋ T lymphocytes had no difference between the two groups（P 〉 0.05）.The plasma concentration of TNF-α in healthy volunteers,pyemia patients and and septic shock patients in baseline was（16.44±9.55）pg/mL,（29.58±13.6）pg/mL and（47.99±25.63） pg/mL respectively.And it was higher in septic shock patients than in pyemia patients（P 〈 0.05）.And the later

关 键 词：感染性休克 淋巴细胞 凋亡 氢化可的松 

分 类 号：R631[医药卫生—外科学]