动态监测脓毒症患者辅助性T淋巴细胞亚群变化及其临床意义  

Dynamic monitoring of helper T lymphocyte subset level in septic patients and its clinical significance

作　　者：穆雪鹍[1,2] 韩雪梅 李亚珍[1,2] 陈子盛[1,2] 傅应云[1,2] 

机构地区：[1]暨南大学第二附属医院 [2]深圳市人民医院呼吸内科,深圳518020

出　　处：《上海医学》2011年第6期441-443,共3页Shanghai Medical Journal

基　　金：广东省医学科学技术研究基金项目资助(A2007563)

摘　　要：目的通过监测脓毒症患者外周静脉血中辅助性T淋巴细胞(Th)亚群的动态变化,评价患者的免疫状态及其与疾病的严重程度和预后的关系。方法在患者被诊断为脓毒症后的第1、4、7、14、28天或出重症监护病房(ICU)及死亡前(将第28天或出ICU或死亡前作为最后一次)抽取外周静脉血,应用流式细胞仪检测细胞表面分子标记为CD3+和CD8-的T淋巴细胞中的白细胞介素(IL)-4和干扰素(IFN)-γ的含量,计算Th1、Th2百分率和Th1/Th2比值,判断外周血中的Th1/Th2漂移现象,并记录当天的急性生理和慢性健康状况评分Ⅱ(APACHEⅡ评分)。结果根据2011年美国危重病学会/欧洲危重病医学会/美国胸科医师协会/美国胸科协会/美国外科学会联席会议提出的脓毒症和重度脓毒症的诊断标准,本组22例患者中,脓毒症组9例,重度脓毒症组13例。重度脓毒症组总体的Th1百分率、Th1/Th2比值分别为(8.5±6.8)%、0.7±0.3,显著低于脓毒症组的(14.9±2.7)%、1.9±0.5(P值均<0.01);Th2百分率为(20.1±13.0)%,显著高于脓毒症组的(8.1±5.9)%(P<0.01)。APACHEⅡ评分与Th1百分率(r=-0.458,P<0.01)、Th1/Th2比值(r=-0.439,P<0.01)呈负相关。重度脓毒症组患者入院第4天起Th1百分率及Th1/Th2比值随时间迁延呈下降趋势,Th2百分率呈上升趋势,与脓毒症组间的差异有统计学意义(P值均<0.01)。结论重度脓毒症患者存在明显的Th1/Th2漂移现象。Objective To monitor the changes of helper T lymphocyte（Th） subset level in septic patients,so as to discuss the relationship of immune status with severity and prognosis of sepsis.Methods After the diagnosis of sepsis was made,the acute physiology and chronic health evalution（APACHE Ⅱ） scores,percentages of Th1,Th2 in the peripheral blood,and the ratio of Th1/Th2 were examined on the 1st,4th,7th,14th and 28th days or the last day in intensive care unit（ICU）.The contents of interleukin（IL）-4 and interferon（IFN）-γ in CD3＋ CD8-T lymphocyte subset were examined by flow cytometry.Results Totally 22 patients were enrolled in this study,with 9 septic and 13 severe septic.The percentage of Th1 and Th1/Th2 ratio in the septic group were significantly lower than those in the severe septic group（[8.5±6.8]% vs.[14.9±2.7]%;0.7±0.3 vs.1.9±0.5,P 0.01）.The percentage of Th2 in the septic group was significantly higher than that in the severe septic group（[20.1±13.0]% vs.[8.1±5.9]%,P0.01）.APACHEⅡ score was negatively correlated with the percentage of Th1 r=-0.458,P0.01） and ratio of Th1/Th2（r=-0.439,P0.01）.From the 4th day after admission,in severe septic group the percentage of Th1 and ratio of Th1/Th2 decreased with time,and the percentage of Th2 cells took an increase tendency,and there was no significant difference compared with the septic group（P0.01）.Conclusions Severe septic patients have a marked Th1/Th2 shift.

关 键 词：脓毒症 辅助性T淋巴细胞 TH1/TH2漂移 急性生理和慢性健康状况评分Ⅱ 

分 类 号：R459.7[医药卫生—急诊医学]