T细胞和Treg细胞表面PD-1水平与脓毒症患者感染程度及近期预后的关系  

Relationship between PD-1 levels on the surface of T cell and Treg cell,the degree of infection,and short-term prognosis in patients with sepsis

作　　者：李康 陈淼 梅鸿 覃松 魏珩 LI Kang;CHEN Miao;MEI Hong;QIN Song;WEI Heng(Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563003,China)

机构地区：[1]遵义医科大学附属医院重症医学科二病区,贵州遵义563003

出　　处：《中华医院感染学杂志》2021年第20期3046-3050,共5页Chinese Journal of Nosocomiology

基　　金：遵义市医药科技发展计划基金资助项目(201711541)。

摘　　要：目的研究外周血T细胞及调节性T(Treg)细胞表面程序性死亡受体-1(PD-1)表达水平与脓毒症患者感染严重程度及近期预后的关系。方法选取遵义医科大学附属医院2017年6月-2019年3月就诊的68例脓毒症患者[脓毒症组(n=42)与严重脓毒症组(n=26)]及健康对照30名(对照组),检测外周血T细胞、Treg细胞百分比及T细胞、Treg细胞表面PD-1表达水平,分析其与脓毒症严重程度评分急性生理学及慢性健康状况(APACHEⅡ)评分、序贯器官功能衰竭评分(SOFA)的关系;根据28 d预后分组,比较两组以上因子表达的差异;受试者工作特征(ROC)曲线分析T细胞、Treg细胞表面PD-1水平预测脓毒症不良预后的价值。结果脓毒症组CD_(4)^(+)T细胞计数低于对照组,CD_(8)^(+)T细胞计数及CD_(4)^(+)CD_(25)^(+)Treg细胞计数及CD_(4)^(+)PD-1、CD_(8)^(+)PD-1、CD_(4)^(+)CD_(25)^(+)PD-1水平均高于对照组(P<0.05);严重脓毒症组CD_(4)^(+)PD-1、CD_(8)^(+)PD-1、CD_(4)^(+)CD_(25)^(+)PD-1及APACHEⅡ评分、SOFA评分均高于脓毒症组(P<0.05);脓毒症患者T细胞、Treg细胞表面PD-1水平与APACHEⅡ评分(r=0.516、0.382、0.498,P均<0.05)、SOFA评分呈正相关(r=0.541、0.318、0.369,P均<0.05);死亡患者CD_(4)^(+) PD-1、CD_(8)^(+) PD-1、CD_(4)^(+)CD_(25)^(+)PD-1水平高于生存组(P<0.05);CD_(4)^(+) PD-1 cut-off值>52.77%时预测脓毒症不良预后敏感度、特异性为70.37%、82.93%;CD_(8)^(+) PD-1 cut-off值>37.00%时预测敏感度、特异性分别为85.19%、60.98%;CD_(4)^(+)CD_(25)^(+)PD-1 cut-off值>7.94%时预测敏感度、特异性分别为59.30%、85.40%。结论脓毒症患者外周血T细胞及Treg细胞表面PD-1呈明显高表达,与脓毒症病情进展及近期不良预后有关。OBJECTIVE To investigate the relationship between expression of programmed death receptor-1(PD-1) on the surface of peripheral blood T cell and regulatory T(Treg) cell,infection severity,and short-term prognosis in sepsis patients.METHODS Sixty-eight patients with sepsis [sepsis group(n=42),severe sepsis group(n=26)] treated in the Affiliated Hospital of Zunyi Medical University from Jun.2017 to Mar.2019 and 30 healthy people(control group) were collected.The percentages of peripheral blood T cells and Treg cells,and expression level of PD-1 on T cell and Treg cell surfaces were detected,and their relationship with scores of sepsis severity,acute physiological and chronic health evaluation II(APACHE II) and sequential organ failure assessment(SOFA) was analyzed.According to the prognosis of 28 d,patients were grouped.The differences in the above factors were compared between the two groups.The receiver operator characteristic(ROC) curves was used to analyze the predictive value of PD-1 level on the surface of T cell and Treg cell in predicting the poor prognosis of sepsis.RESULTS CD_(4)^(+) T cell count in sepsis group was significantly lower than that in control group,while the CD_(8)^(+) T cell count,CD_(4)^(+)CD_(25)^(+)Treg cell count,levels of CD_(4)^(+) PD-1,CD_(8)^(+)PD-1 and CD_(4)^(+)CD_(25)^(+)PD-1 levels were significantly higher than those in control group(P<0.05).The CD_(4)^(+) PD-1,CD_(8)^(+) PD-1,CD_(4)^(+)CD_(25)^(+)PD-1,scores of APACHEII and SOFA in severe sepsis group were significantly higher than those in sepsis group(P<0.05).The levels of PD-1 on the surface of T cells and Treg cell in patients with sepsis were positively correlated with APACHE II score(r=0.516,0.382,0.498,P<0.05) and SOFA score(r=0.541,0.318,0.369,P<0.05).The levels of CD_(4)^(+)PD-1,CD_(8)^(+)PD-1 and CD_(4)^(+)CD_(25)^(+)PD-1 in death group were significantly higher than those in survival group(P<0.05).When the cut-off value of CD_(4)^(+)PD-1 was higher than 52.77%,the sensitivity and specificity for predicting poor progn

关 键 词：脓毒症 调节性T细胞 程序性死亡受体-1 感染 病情 预后 

分 类 号：R459.7[医药卫生—急诊医学]