调节性T细胞及辅助性T细胞17在严重脓毒症患者中的表达及对预后影响  

Expression of regulatory T cells and T helper 17 cells in the prognosis of patients with severe sepsis

作　　者：李国辉[1] 马纪林[2] 周红娟[3] 任丹虹[1] 章佳颖[1] 方堃[1] 蔡龙[3] 

机构地区：[1]杭州市红十字会医院ICU,310003 [2]杭州市红十字会医院肾内科,310003 [3]杭州市红十字会医院风湿免疫实验室,310003

出　　处：《中华危重症医学杂志（电子版）》2014年第6期9-13,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：国家自然科学基金项目(81274121;81001307);杭州市科技发展计划项目(20110833B26);浙江省医药卫生科学研究基金计划项目(2012RCA046);天普研究基金项目(UF201307)

摘　　要：目的观察调节性T细胞及辅助性T细胞17(Th17)在严重脓毒症患者中的表达及对预后的影响。方法将符合严重脓毒症诊断标准的30例患者纳入本研究(脓毒症组),另选择健康体检者30例为对照组。所有严重脓毒症患者在入住重症监护病房(ICU)后1、3、5 d进行采血,健康体检者在体检当天进行抽血。采用流式细胞仪检测外周血CD4+CD25+、CD4+CD25high、CD4+CD25+Foxp3+T细胞及Th17细胞占CD4+T细胞的比率。脓毒症组各时间点的调节性T细胞及Th17水平与对照组比较采用方差分析。将脓毒症组根据28 d病死率将其分成生存组(16例)及死亡组(14例),生存组与死亡组的比较采用t检验。结果对照组CD4+CD25+、CD4+CD25high、CD4+CD25+Foxp3+T细胞及Th17细胞的表达率与脓毒症组入住ICU后1、3、5 d比较,差异均有统计学意义(F=3.267、3.694、9.751、10.881,P均<0.05)。在入住ICU后1、5 d,生存组CD4+CD25+Foxp3+T细胞比率明显高于死亡组(t=2.487、2.689,P均<0.05);而生存组Th17细胞表达率仅在入住ICU后5 d低于死亡组(t=2.522,P<0.05)。结论调节性T细胞及Th17细胞表达率在严重脓毒症患者中明显增高,且为影响预后的重要因素。Objective To observe the expression of regulatory T cells and T helper 17 cells （Thl7）in patients with severe sepsis and their effect on clinical prognosis. Methods Thirty patients defined by severe sepsis diagnostic criteria were enrolled as severe sepsis group, and 30 healthy people served as the control group. The blood samples were collected on days 1, 3, 5 after ICU admission in the severe sepsis group, and on the day of physical examination in the control group. Flow cytometry was used to detect the ratios of peripheral CD4^＋CD25^＋, CD4^＋ CD25^high and CD4^＋CD25^＋Foxp3^＋T cells and Th17 cells over CD4^T cells. The ratios of regulatory T cells and Th17 cells were compared by analysis of variance between the two groups. Meanwhile, the patients in the severe sepsis group were further divided into the survival group （16 cases） and death group （14 cases） based on the 28-day mortality. Results In the control group, the ratios of CD4^＋CD25^＋, CD4^＋CD25^high, CD4^＋CD25^＋Foxp3^＋T cells and Thl7 ceils all showed significant differences as compared with those in the severe sepsis group on days 1, 3, 5 after ICU admission （F= 3.267, 3.694, 9.751, 10.881, all P〈 0.05）. The ratios of CD4^＋CD25^＋ Foxp3^＋T cells in the survival group on days 1, 5 after ICU admission were higher （t = 2.487, 2.689, all P〈 0.05）, and the ratio of Thl7 ceils on the fifth day was lower than those in the death group （t = 2.522, P〈 0.05）. Conclusion The expression of regulatory T cells and Thl7 cells raised significantly in patients with severe sepsis, and is a potential factor of the patient＇s prognosis.

关 键 词：脓毒症 调节性T细胞 辅助性T细胞17 预后 

分 类 号：R459.7[医药卫生—急诊医学]