Th1/Th2、Th17/Treg及其相关转录因子在儿童脓毒血症早期体液中的变化  

Changes of Th1/Th2 and Th17/Treg and relative transcription factor in children with sepsis in the early period

作　　者：李岑[1] 黄栋[1] 王予川[1] 吴大琴 姜军[1] 刘洪栋[1] 成小蓉[1] Li Cen;Huang Dong;Wang Yucuan;Wu Daqin;Jiang Jun;Liu Hongdong;Cheng Xiaorong(Guizhou Provincial People＇s Hospital,Guiyang 550002,Guizhou,China)

机构地区：[1]贵州省人民医院,贵州贵阳550002

出　　处：《贵州医药》2018年第11期1286-1288,1299,共4页Guizhou Medical Journal

基　　金：贵州省卫生厅基金课题(编号:gzwkj2012-1-039);2012年贵州省科教青年英才培养工程(自然科学类)合同编号:黔省专合字(2012)182号

摘　　要：目的观察脓毒症患儿疾病早期的免疫状况,了解T免疫调节细胞Th1/Th2、Th17/Treg及其相关转录因子在体液中的变化。方法 PICU收治的脓毒症患儿20例,于入院后12h内采集静脉血,采用流式细胞术检测外周血CD14^+单核细胞HLA-DR表达、CD4^+CD25^+Foxp3调节性T细胞(Treg)比例及IL-27、CD4^+T细胞比例;Ficoll密度梯度离心法+免疫磁珠分离外周血CD4^+T细胞,采用实时荧光定量PCR(Real time-PCR)检测CD4^+T细胞、Foxp3、CTLA-4、GITR、IL-10、IL-17A、IL-17F、IL-27mRNA;ELISA法检测血清IL-4、IFN-γ、TGF-β蛋白水平,分析T免疫调节细胞在儿童脓毒症体液中的状态及与其相关性。结果脓毒症组CD14^+单核细胞HLA-DR表达率(%)均>30%,但显著低于正常对照组(P<0.01)。前炎症细胞因子IFN-γ血浓度高于对照组(P<0.01),IL-17A、IL-17FmRNA表达均高于对照组(P<0.01)。抗炎症细胞因子TGF-β血浓度低于对照组(P<0.05);Foxp3、CTLA-4、IL-10mRNA表达均高于对照组(P<0.01);IL-4浓度差异无统计学意义(P>0.05);IFN-γ/IL-4比值显著高于对照组(P<0.01)。外周血Treg细胞比例显著低于对照组(P<0.01),GITR差异无统计学意义(P>0.05)。结论儿童脓毒症早期即存在免疫激活与免疫抑制,但以免疫激活占优势。Objective To observe the early immune status in children with sepsis, understand the immunoregulatory mechanism of Th1/Th2 ancl Th17/Treg ancl relative transcription factor ancl provide a theory basis of the new therapy for sepsis. Methods 20 children with sepsis and 20 age-matched children？ undergoing elective operation in Pediatric Surgery Department were studied. Their ages are between 2 years old to 13 years old, the average age was 7.5 years. CD14＋ monocyte HLA DR expression and proportion of CD4＋ CD25＋ foxp3 regulatory T cells （Treg cells） and IL 27＋CD4＋ cell were analyzed by flow cytometry. Real time PCR were used to evaluate the mRNA levels of Foxp3, CTLA 4, GITR, IL-10, L-17A, IL-17 Fand IL-27 in CD4＋Cells. Cytokine （IL-4, IFN-γ and TGF-β）were measured by enzyme linked immunosorbent assay （ELISA）. Results The HLA DR expression in sepsis group was lower than that of controls, but all the ratio was 〉30%. Expression changes of cytokines in serum： concentra tions of pro inflammatory cytokine （IFN-γ） in serum were higher in sepsis group than that of controls （P〈0.01） and the mRNA level of IL-17A, IL-17F was significantly elevated in case group. On the other hand, the protein lev el of anti inflammatory cytokine TGF-β in sepsis group was lower than that of controls （P〈0.05）. There were no statistical significantly differences of IL-4 between case ancl control group. The mRNA level of IL-10 was signifi cantly raised in case group （P〈0.01）. The proportion of CD4＋ CD25＋ Treg in peripheral blood in sepsis group was found to be significantly lower than that of control group （P〈0.01）. Transcription levels of three genes associated with CD4＋ CD25＋ Treg （Foxp3, CTLA-4 and IL-10） in sepsis group were detected to be higher than those in control group （P〈0.01）and there were no statistical significantly differences of GITR mRNA between patients with sepsis and the controls （P〈0.05）. According to the serum concentration of IFN-γ and IL-4

关 键 词：儿童 脓毒症 T免疫调节细胞 

分 类 号：R720.597[医药卫生—急诊医学]