T细胞活化谱对不同病原菌感染脓毒症的诊断价值  

The clinical diagnostic value of T cell activation spectrum in distinguishing sepsis caused by different pathogens

作　　者：王晓园 兰智新 喻露 杭琼 张海涛[1] 刘畅[1] WANG Xiaoyuan;LAN Zhixin;YU Lu;HANG Qiong;ZHANG Haitao;LIU Chang(Intensive Care Department,Shanghai Jiao Tong University Affiliated Ruijin Hospital Wuxi Branch,Wuxi,Jiangsu 214000,China;不详)

机构地区：[1]上海交通大学附属瑞金医院无锡分院重症医学科,江苏无锡214000

出　　处：《中国微生态学杂志》2024年第5期558-562,568,共6页Chinese Journal of Microecology

基　　金：无锡市科研项目(Z202302)。

摘　　要：目的探讨T细胞活化谱对不同病原菌感染的脓毒症的临床诊断价值。方法选取2020年1月至2023年1月在上海交通大学附属瑞金医院无锡分院重症医学科接受治疗的100名脓毒症患者作为脓毒症组,选取同期在我院门诊进行体检的37名健康志愿者作为对照组。脓毒症组根据患者入院时病原学检测结果进一步分为革兰阴性组(G−组,n=46)和革兰阳性组(G^(+)组,n=54)。通过流式细胞仪检测患者外周血中T淋巴细胞和表面共刺激分子的表达。采用受试者操作曲线(ROC)评估CD38^(+)HLA-DR^(+)T细胞区分G−脓毒症和G^(+)脓毒症的能力。结果G−组和G^(+)组患者外周血中CD4^(+)CD38^(+)CD69^(+)T细胞和CD8^(+)CD38^(+)CD69^(+)T细胞比例均高于对照组(均P<0.05)。G^(+)组和G−组患者的CD4^(+)CD38^(+)CD69^(+)T细胞和CD8^(+)CD38^(+)CD69^(+)T细胞比例差异无统计学意义(P>0.05)。与对照组相比,脓毒症各亚组患者外周血中CD4^(+)CD38^(+)HLA-DR^(+)、CD8^(+)CD38^(+)HLA-DR^(+)表达水平增加(均P<0.05),且G−组的增加程度大于G^(+)组(P<0.05)。在区分G−脓毒症和G^(+)脓毒症时,CD4^(+)CD38^(+)HLA-DR^(+)T细胞的AUC为0.901(95%CI:0.837~0.965),特异度为0.867(95%CI:0.738~0.937),敏感度为0.836(95%CI:0.717~0.911);CD8^(+)CD38^(+)HLA-DR^(+)T细胞的AUC为0.927(95%CI:0.872~0.982),特异度为0.778(95%CI:0.662~0.891),敏感度为0.933(95%CI:0.821~0.977)。结论HLA-DR参与了脓毒症患者外周血中T细胞活化的关键免疫反应,对于区分不同病原菌感染脓毒症有一定的价值。Objective To explore the clinical diagnostic value of T cell activation spectrum in distinguishing sepsis caused by different pathogens.Methods A total of 100 sepsis patients who received treatment in our department from January 2020 to January 2023 were selected as the sepsis group,and 37 healthy volunteers who underwent physical examinations in the outpatient department were selected as the control group.The sepsis group was divided into Gram negative group(G−group,n=46)and Gram positive group(G^(+)group,n=54)based on the patient's pathogen detection results upon admission.The expressions of T lymphocytes and surface co-stimulatory molecules in peripheral blood were detected with flow cytometry,and the subject operating curve(ROC)was used to evaluate the ability of CD38^(+)HLA-DR^(+)T cells to differentiate between G−sepsis and G^(+)sepsis.Results The proportion of CD4^(+)CD38^(+)CD69^(+)T cells and CD8^(+)CD38^(+)CD69^(+)T cells in peripheral blood of G−group and G^(+)group were higher than those of the control group(all P<0.05).There were no statistically significant difference in the proportion of CD4^(+)CD38^(+)CD69^(+)T cells and CD8^(+)CD38^(+)CD69^(+)T cells between the two groups(all P>0.05).Compared with the control group,the expression levels of CD4^(+)CD38^(+)HLA-DR^(+)and CD8^(+)CD38^(+)HLA-DR^(+)in peripheral blood of each subgroup of sepsis increased(all P<0.05),and the degree of increase in the G−sepsis group was higher than that in the G^(+)sepsis group(P<0.05).When distinguishing between G−sepsis and G^(+)sepsis,the AUC of CD4^(+)CD38^(+)HLA-DR^(+)T cells was 0.901(95%CI:0.837-0.965),with a specificity of 0.867(95%CI:0.738-0.937)and a sensitivity of 0.836(95%CI:0.717-0.911).The AUC of CD8^(+)CD38^(+)HLA-DR^(+)T cells was 0.927(95%CI:0.872-0.982),with a specificity of 0.778(95%CI:0.662-0.891)and a sensitivity of 0.933(95%CI:0.821-0.977).Conclusion HLA-DR is involved in the key immune response of T cell activation in the peripheral blood of patients with sepsis,and has certain value in

关 键 词：T细胞活化谱 毒症 病原菌 HLA-DR 

分 类 号：R446.5[医药卫生—诊断学]