PICU危重症患者免疫变化研究  

The immune changes of critically ill patients in PICU

作　　者：幸春林[1] 孙金峤[1] 张晓磊[1] 陆国平[1] Xing Chunlin Sun Jinqiao Zhang Xiaolei Lu Guoping.(Department of Critical Care Medicine, Children＇ s Hospital Affiliated to Fudan University, Shanghai 201102, China)

机构地区：[1]复旦大学附属儿科医院重症医学科,上海201102

出　　处：《中国小儿急救医学》2017年第2期118-122,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的研究危重症儿童细胞免疫及体液免疫的变化情况。方法选取复旦大学附属儿科医院2015年4月至2015年9月PICU患儿73例，取入院48 h内外周血，采用流式细胞仪检测淋巴细胞亚群、速率免疫散射比浊法测体液免疫水平、流式细胞仪-DHR分析法测中性粒细胞功能。23例患儿于入院第7天做第2次检测。选择外科择期手术前患儿10例作为对照组。结果（1）入院48 h内，危重症患儿CD3^＋T细胞和CD8^＋T细胞的比例为（57.43±13.46）%、（21.26±7.87）%，较对照组[（66.24±5.27）%、（26.82±7.63）%]明显降低（P〈0.05）；CD4^＋T细胞和NK细胞的比例为（33.42±11.29）%、（8.83±7.77）%，较对照组[（34.89±4.94）%、（11.34±5.60）%]无显著变化（P〉0.05）；B细胞比例[（31.69±13.83）%]较对照组[（21.08±7.24）%]明显升高（P〈0.05）；中性粒细胞活化率[（14.32±14.81）%]与正常参考值（0～10%）相比明显升高，受PMA刺激后活化率大于90%；补体C3血浆水平[（0.88±0.31）g/L]较对照组[（1.19±0.18）g/L]明显降低（P〈0.05）。（2）23例患儿治疗1周后CD3^＋细胞、CD4^＋细胞比例[（61.20±13.56）%、（36.79±9.95）%]较初入ICU时[（56.80±13.99）%、（32.86±10.87）%]显著升高（P〈0.05），中性粒细胞活化情况和PMA刺激后活化率与入院时比较无显著差异，IgA、IgM和补体C3[（0.98±0.75）g/L、（1.00±0.39）g/L、（1.15±0.34）g/L]较入ICU时[（0.80±0.69）g/L、（0.86±0.48）g/L、（0.93±0.23）g/L]显著升高（P〈0.05）。结论儿童危重症患者在疾病初期出现免疫紊乱，细胞免疫变化最明显，1周后免疫指标有所恢复。Objective To investigate the changes of cellular immunity and humoral immunity in children with acute or critical illness. Methods Seventy-three critically ill children admitted to PICU of Children＇s Hospital Affiliated to Fudan University during the period from April ,2015 to September,2015 were the objects of study. Blood samples were collected within 48 hours after admition. The lymphocyte subpopulation was measured by flow cytometry, and the level of humoral immunity was measured by rate immune scatter turbidimetry, and the neutrophil function was measured by flow cytometry-DHR analysis. Twenty-three cases from 73 cases were detected the second time after admitted to hospital for seven days. Ten health children before elective surgery were selected as control. Results （ 1 ） Compared with the control, the percentages of CD3 ^＋ T cells and CD8 ^＋ T cells were significantly decreased in critically ill children within 48 hours of admistion[ （57.43 ± 13.46） %, （ 21.26 ±7.87 ） % vs. （66.24 ± 5.27 ） %, （ 26. 82±7. 63 ） % , P 〈 0. 05 ] ; At the same time,CD4 ^＋ T cells and NK cells had no significant change[ （33.42 ±11.29）% ,（8.83 ±7.77）% vs. （ 34. 89 ±4. 94 ） % （ 11.34± 5.60 ） %, both P 〉 0. 05 ] ; While B cells were significantiy increased [（ 31.69± 13.83 ） % vs. （21.08 ± 7.24） %, P 〈 0. 05 ]. Neutrophil activation rate [ （ 14. 32± 14. 81 ） %] was significantly higher than the normal reference value（0 - 10% ） and the activation rate was more than 90% after stimulated by PMA. The plasma level of complement C3 [ （0. 88 ＋ 0. 31 ） g/L] was lower than that of the control group [ （ 1.19 ＋ 0. 18） g/L, P 〈 0. 051. （ 2 ） Compared with the first time, the percentages of CD3 ＋ cells and CD4 ＋ cells were increased after treated for one week in 23 patients[ （61.20 ±13.56） %, （36. 79 ±9.95） % vs. （56. 80 ＋ 13.99） %, （32. 86 ±10. 87） % ,both P 〈0. 05]. No significant difference in neutrophil activation and act

关 键 词：儿童 危重症 免疫 紊乱 

分 类 号：R720.597[医药卫生—急诊医学]