CD4＋CD25＋CD127lowTreg细胞在脓毒症免疫麻痹中的作用及其对预后的判断价值  

Study of CD4＋ CD25＋ CD127^lowWTreg cells in the pathogenesis of sepsis immune paralysis and its prognostic value

作　　者：王秋卉[1] 严洁[1] 高飞[1] 

机构地区：[1]无锡市人民医院重症医学科,江苏无锡242023

出　　处：《中国急救医学》2014年第3期208-211,共4页Chinese Journal of Critical Care Medicine

基　　金：南京医科大学科技发展基金项目（2011NJMU042）

摘　　要：目的研究脓毒症患者外周静脉血CD4＋CD25＋CDl27^lowTreg比例在免疫麻痹中的作用，探讨其对脓毒症病情严重程度和预后判断的价值。方法选择确诊的脓毒症患者40例为脓毒症组、健康成人20例为对照组，分别在病程第1、3、5、7天采血，用流式细胞技术检测CD4＋CD25＋CDl27^lowTreg和HLA—DR／CDl4＋水平，并记录临床数据。根据HLA—DR／CD14＋单核细胞比例〈30％分为免疫抑制组（〈30％）和非免疫抑制组（〉30％），根据病情严重程度分为脓毒症组、严重脓毒症组，根据预后分为存活组和死亡组。结果在第1、3、5天，脓毒症组患者CD4＋CD25＋CDl27^low Treg较对照组明显增高（P〈0．01），其变化与HLA—DR／CDl4＋表达水平呈负相关（P〈0．01）；免疫抑制组CD4＋CD25＋CD127^lowTreg比例高于非免疫抑制组（P〈0．05）。入组时CD4＋CD25＋CD127^lowTreg和HLA—DR／CDl4＋与严重脓毒症患者的预后相关。结论CD4＋CD25＋CD127^lowTreg可能通过下调HLA—DR／CDl4＋对脓毒症患者免疫功能产生影响，其表达水平与脓毒症患者的预后有关。Objective To analyze the relationship between the changes and the occurrence of immune paralysis, and to further explore the significance of CD4＋ CD25 ＋ CD127^lowTreg in the sepsis severity and prognosis. Methods The 40 patients with sepsis admitted to ICU were enrolled in the study as sepsis group, and 20 healthy volunteers as control group. CD4＋ CD25 ＋ CD127^low Treg and HLA -DR were detected by flow cytometry, and clinical signs were recorded respectively at the 1st, 3rd, 5th, 7th d. According to the HLA- DR/CD14 ＋ monocyte ratio 〈 30%, the patients were divided into immunosuppressed group （ 〈 30% ） and unimmunosuppressed group （ 〉 30% ）. According to the disease severity and the prognosis of sepsis, the patients were further divided into sepsis group and severe sepsis group, death group and survival group. Results CD4＋ CD25＋ CD127^low Treg cell ratio were significantly higher in sepsis group than in control group at the 1st, 3rd, 5th d（P 〈 0.01 ）. Correlation analysis showed the negative correlation between CD4＋ CD25＋ CD127^low Treg cells and HLA -DR/CD14＋ monocytes ratio in sepsis group. The CD4＋ CD25＋ CD127^lowTreg ratio was higher in immunesuppression group than in immune activation group （ P 〈 0.05）. The proportion of CD4＋ CD25＋ CD127^lowTreg cells, HLA- DR/CD14＋ monocyte ratio may be the effective prognostic indicators for severe sepsis. Conclusion In the patients with sepsis, peripheral blood CD4＋ CD25＋ CD127^low Treg expression level with HLA - DR expression level better correlation may be prompted in the immune paralysis state. It＇s expression levels may he used for the prognosis of patients with sepsis, may be theearly onset of sepsis - assisted evaluation of the severity index.

关 键 词：脓毒症 调节性T细胞 免疫麻痹 流式细胞术 预后 

分 类 号：R572[医药卫生—消化系统]