外周血Th17细胞对脓毒症急性肺损伤病情严重程度及预后的评估价值  

Value of peripheral Th17 cells in evaluation and prognosis of acute lung injury in sepsis

作　　者：周洪[1] 綦俊[1] 张奇[1] 尹哲[1] 张智[1] 

机构地区：[1]重庆市肿瘤研究所胸外科,重庆400030

出　　处：《现代免疫学》2016年第2期113-117,共5页Current Immunology

摘　　要：观察脓毒症急性肺损伤患者外周血Th17细胞水平与病情严重程度及预后的关系，探讨其在脓毒症急性肺损伤发生发展中的临床作用。以190例脓毒症患者为研究对象，按临床表现分为脓毒症普通组（110例）和脓毒症肺损伤组（80例）。根据脓毒症肺损伤患者病情严重程度将其分为低危组（29例）、中危组（28例）和高危组（23例）；按脓毒症肺损伤患者临床结局将其分为存活组（64例）和死亡组（16例）。采用流式细胞仪检测各组外周血Th17细胞比例，同时记录急性生理学与慢性健康状况（APACHE Ⅱ）评分情况，分别比较各组外周血Th17细胞比例及APACHE Ⅱ评分水平的差异以及Th17细胞水平与APACHE Ⅱ评分的相关性，评价外周血Thl7细胞水平对脓毒症肺损伤患者病情严重程度与临床预后的评估价值。结果显示脓毒症肺损伤组患者外周血Thl7细胞及IL-17水平明显高于脓毒症普通组患者（P〈0．05）；低危组、中危组及高危组间外周血Thl7细胞水平、IL-17及APACHE Ⅱ评分的差异具有统计学意义（P〈0．05），其中，高危组外周血Thl7细胞水平、IL-17及APACHE Ⅱ评分最高，中危组次之，低危组最低（P〈0．05）；死亡组外周血Thl7细胞水平、IL-17及A-PACHE Ⅱ评分显著高于存活组（P〈0．05）。相关性分析显示，血清外周血Thl7细胞水平与APACHE Ⅱ评分（r=0．81，P=0．00）及死亡率（r=0．43，P=0．00）呈正相关。ROC曲线分析显示，外周血Thl7细胞水平曲线下面积（ACU）为0．842（95％CI：0．784～0．908），其最佳工作点为7．0％，此时判断脓毒症肺损伤患者预后不良的敏感度和特异度分别为81．83％和86．82％。研究表明脓毒症急性肺损伤患者外周血Thl7细胞水平的增加与其病情严重程度及预后密切相关，其可作为一项有效的预测指标，具有一定的临床应用价值。This study aimed to investigate the relationship between Thl7 cell levels and severity of acute lung injury in patient with sepsis and to explore its clinical significance in the pathogenesis of the lung injury. One hundred and ninety patients with sepsis were enrolled in this study. The patients with sepsis were divided into a mild sepsis group （110 cases） and a sepsis with acute lung injury group （80 cases） according to the clinical manifestations. According to the severity of the disease, these pa- tients with acute lung injury were subdivided into low-risk group （29 cases）, moderate-risk group （28 cases） and high-risk group （23 cases）. According to clinical prognosis, these patients with acute lung injury were further divided into survival （64 cases） and death groups （16 cases）. Percentage of Th17 cells was measured by flow cytometry, and APACHE II score was an- alyzed. The differences of Th17 cells levels in all groups were compared and correlation with APACHE II score was analyzed, and which the relationship with the severity and prognosis were also assessed. The Thl7 cells and IL-17 levels of sepsis with a- cute lung injury group were higher than those of the mild group （P〈0.05） The difference in Th17 cells, IL-17 levels and A- PACHE II score among low-risk group, moderate-risk group and high-risk group were statistically significant, and correlated with severity of lung injury （in which high-risk group was the highest, followed by moderate-risk group, low-risk group was the lowest） （P〈0.05） Compared the survival group, the death group had higher Thl7 levels and IL-17 concentrations as well as APACHE II score （P〈0.05）. The Th17 cell level correlated positively both to APACHE II score （r=0.81, P=0.00） and mortality （r=0.43,P = 0.00）. ROC curves analysis showed that the area under curve of Thl7 cells was 0. 842 （95% CI： 0. 784～0. 908）, and optimal operating point （OOP） was 7.0%, and at this point, the sensitivity and specificity to evalua

关 键 词：TH17细胞 脓毒症 预后 急性肺损伤 急性生理学与慢性健康状况评分 

分 类 号：R459.7[医药卫生—急诊医学]