胸部创伤患者早期血清调节性T淋巴细胞及Th1/Th2细胞因子变化与创伤后感染的关系  

Relationship between early changes of serum regulatory t-lymphocytes and Th1/Th2 cytokines and posttraumatic infection in patients with chest trauma

作　　者：李莲英[1] 刘凤娟[1] 丁密[1] 张彬彬[1] 王啸林 LI Lianying;LIU Fengjuan;DING Mi;ZHANG Binbin;WANG Xiaolin(Department of Thoracic Surgery,Henan Provincial Chest Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省胸科医院胸外一病区,郑州450008

出　　处：《实用医学杂志》2021年第15期1967-1971,共5页The Journal of Practical Medicine

基　　金：河南省医学科技攻关计划项目(编号:2018132326)。

摘　　要：目的探讨胸部创伤患者早期血清调节性T淋巴细胞及辅助型T细胞1/辅助型T细胞2(Th1/Th2)细胞因子变化与创伤后感染的关系。方法选择160例胸部创伤患者作为研究对象,根据是否发生感染分为感染组与非感染组。详细记录患者基本信息,记录入院后24 h内白细胞(WBC)、降钙素原(PCT)、外周血CD4+/CD25+T淋巴细胞数量及Th1相关细胞因子γ干扰素(IFN-γ)、Th2相关细胞因子白细胞介素-4(IL-4)水平。分析影响胸部创伤后感染发生的因素。结果(1)160例胸部创伤患者有46例并发感染,占28.75%;有114例未并发感染,占71.25%。(2)感染组与非感染组年龄、机械通气时间、合并脑损伤、ISS评分、APACHE-Ⅱ评分比较差异有统计学意义(P<0.05)。(3)感染组PCT、WBC、IFN-γ/IL-4均高于非感染组(P<0.05);CD4+/CD25+低于非感染组(P<0.05)。(4)多因素logistic回归分析显示:机械通气时间、合并脑损伤、ISS评分、APACHE-Ⅱ评分、PCT、IFN-γ/IL-4,CD4+/CD25+是胸部创伤发生感染的危险因素(P<0.05)。结论胸部创伤后早期机体免疫功能紊乱,高龄、脑损伤、ISS评分高、APACHE-Ⅱ评分高、IFN-γ/IL-4升高及CD4+/CD25+降低等多种因素可增加患者创伤后感染的风险。Objective To investigate the relationship between early changes of serum regulatory T lymphocytes and helper T cell 1/helper T cell 2(Th1/Th2)cytokines and post-traumatic infection in patients with chest trauma.Methods A total of 160 patients with chest trauma were selected and divided into infected group and noninfected group.The basic information of the patient was recorded in detail.White blood cell(WBC),procalcitonin(PCT),CD4+/CD25+T lymphocyte count,Th1 related cytokineγinterferon(IFN-γ)and Th2 related cytokine interleukin-4(IL-4)levels within 24 h after admission were also recorded.The factors of infection after thoracic trauma were analyzed.Results(1)Among 160 patients with chest trauma,46 cases(28.75%)were complicated with infection,while 114 cases(71.25%)were not.(2)There were significant differences in age,mechanical ventilation time,combined brain injury,ISS score and APACHE-Ⅱscore between the infected group and the non-infected group(P<0.05).(3)The level of PCT,WBC,and IFN-γ/IL-4 in the infected group was higher than that in the non-infected group(P<0.05).The level of CD4+/CD25+in the infected group was lower than that in the non-infected group(P<0.05).(4)Multi-factor logistic regression analysis showed that the duration of mechanical ventilation,combined with brain injury,ISS score,APACHE-Ⅱscore,PCT,IFN-γ/IL-4,and CD4+/CD25+were the significant or correlated factors of the infection in patients with chest trauma(P<0.05).Conclusion In the early stage of post-traumatic infection,patients have immunologic dysfunction.Advanced age,brain injury,high ISS score,high APACHE-Ⅱscore,increased IFN-γ/IL-4 and decreased CD4+/CD25+,may increase the risk of posttraumatic infection.

关 键 词：胸部创伤 调节性T淋巴细胞 TH1/TH2细胞因子 创伤后感染 γ干扰素 白细胞介素-4 

分 类 号：R631[医药卫生—外科学]