在重症急性胰腺炎患者继发感染中调节性T细胞/辅助性T细胞17失衡的机制研究  

Mechanism of regulatory T cells/T helper cell 17 imbalance in patients with pancreatic infection secondary to severe acute pancreatitis

作　　者：孙亚慧 李甜甜 Sun Yahui;Li Tiantian(Department of Critical Care,Jinan Laiou People 8s Hospial,Jinan 271100,China;Department of Critical Care Medicine,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]济南市莱芜人民医院重症科,济南271100 [2]山东第一医科大学附属省立医院重症医学科,济南250021

出　　处：《中华危重症医学杂志（电子版）》2023年第6期475-480,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：山东省科技发展计划项目(2018GSF119071)。

摘　　要：目的探讨重症急性胰腺炎(SAP)患者继发胰腺感染中调节性T细胞/辅助性T细胞17(Treg/Th17)失衡相关机理.方法收集2019年3月至2021年3月于济南市莱芜人民医院就诊的60例SAP患者,根据是否继发胰腺感染将其分为感染组(30例)和未感染组(30例).另选取50例无发热感染症状的同期健康体检者作为对照组.检测感染者病原菌分布,评估病情严重程度,检测入院时血清淀粉酶、血钙、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)、T细胞亚群水平,分析SAP患者继发胰腺感染Treg/Th17失衡的机制.结果感染组患者的病原菌中革兰阳性菌占56.7%(38/67),革兰阴性菌占43.3%(29/67).感染组患者的急性病生理学和长期健康评价(APACHE)Ⅱ评分[(20±4)分vs.(14±5)分,t=4.814,P<0.001]与Ranson评分[(6.1±2.0)分vs.(4.0±1.9)分,t=4.116,P<0.001]均高于未感染组.3组受试者血清淀粉酶、血钙、TNF-α、IL-6、CRP以及CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)T细胞亚群水平比较,差异均有统计学意义(F=1042.671、4.018、6.871、10542.863、306.755、69.062、36.185、37.974、5.221,P均<0.05).进一步两两比较发现,未感染组和感染组患者血清淀粉酶、TNF-α、IL-6、CRP及CD4^(+)/CD8^(+)水平均较对照组显著升高,且感染组更高(P均<0.05);CD3^(+)、CD4^(+)、CD8^(+)水平均较对照组显著降低,且感染组CD3^(+)水平更低(P均<0.05);感染组血钙水平较对照组和未感染组均显著降低(P均<0.05).结论病原菌感染引起的胰腺感染患者CD3^(+)、CD4^(+)、CD8^(+)水平降低,CD4^(+)/CD8^(+)升高,促使TNF-α、IL-6、CRP高表达,促炎症因子升高,引起严重病理损伤.Objective To investigate the mechanism of regulatory T cells/T helper cell 17(Treg/Th 17)imbalance in patients with pancreatic infection secondary to severe acute pancreatitis(SAP).Methods Sixty SAP patients in Jinan Laiwu People's Hospital from March 2019 to March 2021 were collected,who were divided into a infected group(30 cases)and a uninfected group(30 cases).In addition,50 healthy persons taking physical examination without symptoms of febrile infection were selected as the control group.The distribution of pathogenic bacteria in the infected patients was detected,the severity of the disease was assessed,and the serum amylase,blood calcium,tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)and T cell subgroup levels were measured.Then the mechanism of Treg/Th17 imbalance in patients with pancreatic infection secondary to SAP was analyzed.Results Among the pathogens in the infected group,gram-positive bacteria were 56.7%(38/67),and gram-negative bacteria were 43.3%(29/67).The acute physiology and chronic health evaluation(APACHE)Ⅱscore[(20±4)vs.(14±5),t=4.814,P<0.001]and Ranson score[(6.1±2.0)vs.(4.0±1.9),t=4.116,P<0.001]in the infected group were higher than those in the uninfected group.There were significant differences in the levels of serum amylase,blood calcium,TNF-α,IL-6 and CRP in the infected,uninfected and control groups,as well as the levels of CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)T cell subgroups(F=1042.671,4.018,6.871,10542.863,306.755,69.062,36.185,37.974,5.221;all P<0.05).Further pairwise comparisons found that the serum amylase,TNF-α,IL-6,CRP and CD4^(+)/CD8^(+)levels of the uninfected and infected groups were significantly higher compared with the control group,which were highest in the infected group(all P<0.05).The CD3^(+),CD4^(+)and CD8^(+)levels of the uninfected and infected groups were significantly lower compared with the control group,and the CD3^(+)level was lowest in the infected group(all P<0.05).The blood calcium level in the infected grou

关 键 词：重症急性胰腺炎 胰腺感染 调节性T细胞/辅助性T细胞17失衡 机理研究 

分 类 号：R576[医药卫生—消化系统]