重症机械通气患者Th17/Treg细胞平衡与困难撤机结局的相关性  

The Correlation Between Th17/Treg Cell Balance and Difficult-Removing-Machine Outcome in Patients with Severe Mechanical Ventilation

作　　者：黎宗宝 詹峰[2] 白瑞娜[3] LI Zongbao;ZHAN Feng;BAI Ruina(Department of Emergency,Hainan Provincial People’s Hospital,Haikou 570311,China;Emergency ICU,Hainan Provincial People’s Hospital,Haikou 570311,China;Department of Cardiology,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]海南省人民医院急诊科,海南海口570311 [2]海南省人民医院急诊ICU,海南海口570311 [3]中国中医科学院西苑医院心血管内科,北京100091

出　　处：《标记免疫分析与临床》2021年第3期441-446,451,共7页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金项目(编号:81603489)。

摘　　要：目的观察重症机械通气(MV)患者辅助性T细胞17(Th17)/调节性T细胞(Treg)因子失衡与困难撤机结局的关系,以指导未来重症机械通气患者困难撤机结局的评估与干预。方法选择我院2018年1月至2020年1月收治的214例重症患者作为研究对象,患者有不同程度的自主呼吸困难,均接受MV治疗,对达到撤机标准的患者进行自主呼吸试验(SBT),通过试验者行拔管,观察48h,记录撤机结局。比较不同撤机结局患者的炎症因子[降钙素原(PCT)、C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素-1β(IL-1β)]水平,Th17细胞因子[白细胞介素-6(IL-6)、白细胞介素-17(IL-17)及γ-干扰素(IFN-γ)]水平及Treg细胞因子[转化生长因子-β(TGF-β)、白细胞介素-4(IL-4)及白细胞介素-10(IL-10)]水平,并探讨Th17/Treg细胞平衡状况,分析Th17/Treg细胞失衡对撤机结局的预测价值。结果214例重症MV患者,有89例发生困难撤机结局,发生率为41.59%;困难撤机组IL-6、IL-17及IFN-γ水平均高于撤机成功组,TGF-β、IL-4及IL-10水平均低于撤机成功组(P<0.05);撤机困难组Th17细胞比例、Th17/Treg高于撤机成功组,Treg细胞比例低于撤机成功组(P<0.05);经Logistic回归分析结果显示,IL-6、IL-17及IFN-γ高水平,TGF-β、IL-4及IL-10低水平,Th17细胞高比例,Treg细胞低比例及Th17/Treg高比值是重症MV患者困难撤机结局发生的危险因素(OR>1,P<0.05);绘制ROC曲线发现,Th17细胞比例、Treg细胞比例、Th17/Treg比值用于重症MV患者困难撤机结局风险预测的AUC均>0.80,有一定预测价值,且以Th17/Treg比值的预测价值高;当各细胞cut-off值取分别取4.180%、4.860%、0.779%时,可得到最佳预测价值。结论重症MV患者Th17/Treg细胞平衡与困难撤机结局密切相关,Th17/Treg细胞高比例可导致困难撤机发生,可将Th17/Treg细胞作为困难撤机结局的有效预测因子。Objective To observe the relationship between helper T cell 17(Th17)/regulatory T cell(Treg)factor imbalance and difficult-removing-machine outcome in severe mechanical ventilation(MV)patients,so as to guide the difficult removing machine outcome of severe mechanical ventilation in the future evaluation and intervention.Methods 214 severe patients treated in our hospital from January,2018 to January,2020 were selected as the research objects.Patients with various degrees of spontaneous breathing difficulties were treated with MV.Spontaneous breathing test(SBT)was performed on patients who reached the standard of removing machine,and the tester was extubated,observed for 48 hours,and recorded for the outcome of removing.We then compared the levels of inflammatory factors[procalcitonin(PCT),C-reactive protein(CRP),tumor necrosis factor(TNF-α),interleukin-1β(IL-1β)],levels of Th17 cytokines[interleukin-6(IL-6),interleukin-17(IL-17)and interferon-γ(IFN-γ)]and Treg cytokine[transforming growth factor-β(TGF-β),interleukin-4(IL-4)and interleukin-10(IL-10)]levels]levels in patients with different machine-removing outcomes,and explored the balance of Th17/Treg cells,and analyzed the predictive value of Th17/Treg cell imbalance on machine-removing outcomes.Results Of the 214 severe MV patients,89 had difficult-removing-machine outcomes,with the incidence rate of 41.59%.The levels of IL-6,IL-17 and IFN-γof the difficult-removing group were higher than those of the successful-removing group,and TGF-β,IL-4 and IL-10 levels were lower than the successful-removing group(P<0.05).The proportion of Th17 cells and Th17/Treg in the difficult-removing group was higher than that of the successful-removing group,and the proportion of Treg cells was lower than the successful-removing group(P<0.05).The logistic regression analysis results showed that high levels of IL-6,IL-17 and IFN-γ,low levels of TGF-β,IL-4 and IL-10,high proportions of Th17 cells,low proportions of Treg cells,and high Th17/Treg ratios were all risk factors

关 键 词：机械通气 重症 辅助性T细胞17 调节性T细胞 撤机结局 

分 类 号：R473.5[医药卫生—护理学]