脓毒症急性肾损伤患者外周血T淋巴细胞亚群变化及意义  

Alterations and clinical significance of peripheral blood T lymphocyte subsets in patients with septic acute kidney injury

作　　者：唐荣[1] 钟永[1] 肖舟[1] 孟婷[1] 李晓照[1] 肖湘成[1] 周巧玲[1] 

机构地区：[1]中南大学湘雅医院肾内科,长沙410008

出　　处：《中国医师杂志》2015年第3期324-327,共4页Journal of Chinese Physician

基　　金：国家自然科学基金资助项目（81173401）

摘　　要：目的：观察脓毒症及脓毒症急性肾损伤患者外周静脉血T淋巴细胞亚群的水平变化，并探讨其临床意义。方法以55例一般脓毒症患者及43例脓毒症合并急性肾损伤患者为研究对象，同期30例健康体检者为对照组，应用流式细胞仪检测外周血T细胞亚群水平，包括CD3＋T、CD4＋T、CD8＋T细胞百分比及CD4＋T／CD8＋T比值，于入院24 h内进行急性生理和慢性健康状况评分Ⅱ（ APACHEⅡ），并分析APACHE Ⅱ评分与T淋巴细胞亚群的相关性。结果脓毒症急性肾损伤组患者外周血CD3＋T、CD4＋T细胞百分比和CD4＋T／CD8＋T比值明显低于对照组及一般脓毒症组（均P ＜0．05）；脓毒症急性肾损伤3期组外周血CD3＋T、CD4＋T细胞百分比和CD4＋T／CD8＋T比值明显低于1期和2期组（均P ＜0．05）；脓毒症急性肾损伤患者死亡组CD3＋T、CD4＋T细胞百分比和CD4＋T／CD8＋T比值均较存活组低（均 P ＜0．05）。脓毒症患者APACHEⅡ评分与外周血CD4＋T细胞百分比和CD4＋T／CD8＋T比值均呈负相关（ r ＝－0．645，－0．492， P＜0．05）。结论脓毒症及脓毒症急性肾损伤患者存在着不同程度的细胞免疫失衡，表现为循环CD3＋T、 CD4＋T细胞百分比和CD4＋T／CD8＋T比值的下降，而CD4＋T细胞百分比和CD4＋TC／D 8＋T比值与病情严重程度和预后密切相关。Objective To investigate the alterations of peripheral blood T lymphocyte subsets in patients with sepsis and septic acute kidney injury, and explore the clinical significance.Methods Fifty-five patients with sepsis and forty-three patients with septic acute kidney injury were enrolled in this study. At the same period, thirty healthy subjects were enrolled as the control group.T lymphocyte subsets inclu-ding CD3 ＋T, CD4 ＋T, CD8 ＋T cells, and CD4 ＋T/CD8 ＋T in peripheral blood were detected by flow cy-tometry, and acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ） were graded within twenty-four hours after admission.Then, correlation of the APACHEⅡscores and T lymphocyte subsets was ana-lyzed.Results In the septic acute kidney injury group, peripheral blood CD3 ＋T, CD4 ＋T cell percenta-ges, and CD4 ＋T/CD8 ＋T ratio were significantly lower than those in the control group and the sepsis group （all P 〈0.05）.In the septic acute kidney injury group with stage 3, CD3＋T, CD4 ＋T cell percentages, and CD4 ＋T/CD8 ＋T ratio in the patients were significantly lower than those in stage 1 and stage 2 （ all P 〈0.05）.In the septic acute kidney injury group,CD3 ＋T, CD4 ＋T cell percentages, and CD4 ＋T/CD8 ＋T ra-tio were significantly lower in dead group than those in survival group （all P 〈0.05）.APACHEⅡscores in patients with sepsis were significantly negatively correlated with peripheral blood CD4 ＋T cell percentages and CD4 ＋T/CD8 ＋T ratio （ r =-0.645,-0.492, allP 〈0.05）.Conclusions There are varying de-grees of cellular immune imbalance in patients with sepsis and septic acute kidney injury, characterized by decline of circulating CD3 ＋T, CD4 ＋T cell percentages, and CD4 ＋T/CD8 ＋T ratio.CD4 ＋T cell percenta-ges and CD4 ＋T/CD8 ＋T ratio are closely related to the severity and prognosis of septic acute kidney injury.

关 键 词：脓毒症/并发症/免疫学 肾疾病/并发症/免疫学 T淋巴细胞亚群 

分 类 号：R459.7[医药卫生—急诊医学] R692.5[医药卫生—治疗学]