CD4^＋CD25^＋调节性T细胞在脓毒症预后评价中的应用  

CD4^＋CD25^＋ T regulatory cells in predicting the prognoses of patients with sepsis

作　　者：陈坤[1] 周秋香[1] 单红卫[1] 林兆奋[1] 李文放[1] 

机构地区：[1]第二军医大学附属长征医院急救科,上海200003

出　　处：《中华急诊医学杂志》2015年第1期72-76,共5页Chinese Journal of Emergency Medicine

基　　金：第二军医大学2013年度创新基金资助项目（MS2013068）

摘　　要：目的探讨脓毒症患者外周血中CD4^＋CD25^＋调节性T细胞（Treg）对脓毒症患者预后预测的价值。方法收集上海长征医院2013年12月至2014年4月入院的28例确诊脓毒症患者，根据出院结局分为存活组和死亡组，分别于入院的第1天及第7天采集外周血，流式细胞术检测CD4^＋CD25^＋Treg细胞比例，以及检测血常规、CRP、胆红素、PCT、凝血功能等，并统计APACHEⅡ、SOFA评分，分析各指标第1天及第7天值以及差值对脓毒症预后的预测准确性。结果入组28例病例，年龄（60．36±15．03）岁，APACHEⅡ评分（16．68±7．00），SOFA评分（7．18±3．78）；伴有严重创伤患者12例（42．9％），感染性休克患者10例（35．7％），死亡9例（32．2％）。存活组与死亡组第1天、第7天CD4^＋CD25^＋Treg细胞比例中位数（四分位数）分别为：2．10％（0．80，3．10）％ vs．1．80％（1．15，3．65）％（Z=-0．148，P=0．883）；0．90％（0．30，2．80）％VS．5．70％（2．60，8．30）％（Z=-2．905，P=0．004）。结论动态监测CD4^＋CD25^＋Treg细胞能够准确预测脓毒症患者预后，具有较好的临床应用前景。Objective We aimed to evaluate the role of CD4^＋CD25^＋ T regulatory cells in predicting the prognoses of patients with sepsis. Methods Patients with sepsis in Shanghai Changzheng Hospital from December 2013 to April 2014 were identified and grouped into survival group （SG, n = 19） and death group （ DG, n = 9） in accordance with their clinical outcomes. CD4^＋CD25^＋ T regulatory cell ratio, C-replication protein, bilirubin, proealcitonin, and coagulation function were tested on the 1st day and 7th day, and APACHE I1 and SOFA were analyzed to assess the predictability of this group of cells. Results Twenty-eight patients were identified, with a mean age of （60. 36 ± 15.30 ） years, a mean APACHE II score of （16.68 ±7.00） , and a mean SOFA score of （7. 18 ±3.78）. Twelve （42.9%） of the individuals were accompanied with severe multiple trauma, and 10 （35.7%） were in septic shock, and 9 （32. 2% ） died of severe sepsis. The first day CD4^＋CD25^＋ T regulatory cell ratios on the first day were 2. 10% （ 0. 80, 3.10）% （SG） vs. 1.80% （1.15, 3.65）% （DG） （Z= -0.148, P=0.883）, andonday7 were 0.90% （0.30, 2.80）% （SG） vs. 5.70% （2.60, 8.30）% （DG） （Z= -2.905, P=0.004） presented significant predictability. Conclusions Dynamic monitoring of CD4^＋CD25^＋T regulatory cells could predict the prognoses of patients with sepsis and should be generalized in clinical emergency practice.

关 键 词：脓毒症 调节性T细胞 APACHEⅡ SOFA 

分 类 号：R459.7[医药卫生—急诊医学]