免疫因子及T淋巴细胞亚群监测在脓毒症免疫调理治疗中的指导意义  

Guiding significance of immune factors and T lymphocyte subsets in immuno-modulatory therapy for sepsis

作　　者：赵璟[1] 冯丽霞[1] 史晶心 范风江[1] ZHAO Jing;FENG Lixia;SHI Jingxin;FAN Fengjiang(Nangyang First People's Hospital,Nanyang 473000,China)

机构地区：[1]南阳市第一人民医院,南阳473000

出　　处：《中国免疫学杂志》2024年第12期2614-2622,共9页Chinese Journal of Immunology

基　　金：南阳市2020年市级科技计划项目(KJGG098)。

摘　　要：目的:研究监测免疫因子及T淋巴细胞亚群在脓毒症免疫调理治疗中的指导意义。方法:选取2022年6月至2023年12月南阳市第一人民医院收治的80例脓毒症患者作为脓毒症组,同期健康体检的80例健康志愿者作为健康组,检测健康组体检当日、脓毒症组入组次日免疫调理治疗前、治疗1 d、3 d、7 d免疫因子[补体C3、IgA、IgG、IgM、IFN-γ、程序性细胞死亡受体-1(PD-1)]、T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平,比较两组免疫因子、T淋巴细胞亚群表达。80例脓毒症患者均接受综合治疗,在此期间加用胸腺肽-α1行免疫调理治疗,根据患者免疫调理治疗后病情改善情况[低危组(n=31)、中危组(n=34)、高危组(n=15)]、疾病转归情况[存活组(n=55)、死亡组(n=25)]进行分组,分析入院时免疫因子、T淋巴细胞亚群预测脓毒症患者免疫调理治疗后病情改善情况及疾病转归情况的效能。结果:与健康组比较,脓毒症组免疫因子补体C3、IgA、IgG、IgM、IFN-γ表达水平降低,PD-1 mRNA相对表达量升高,T淋巴细胞亚群CD4^(+)T、CD4^(+)T/CD8^(+)T值降低,CD8^(+)升高(P<0.05)。与治疗前、治疗1 d比较,治疗3 d、治疗7 d脓毒症患者补体C3、IgA、IFN-γ表达水平、T淋巴细胞亚群CD4^(+)T、CD4^(+)T/CD8^(+)T值均显著升高,PD-1 mRNA相对表达量、CD8^(+)T均显著降低(P<0.05)。脓毒症患者免疫调理治疗后病情明显改善,表现为低危比例升高,中危、高危比例降低(Z=6.954,P<0.05)。高危组补体C3、IgA、IgG、IgM、IFN-γ、CD4^(+)T水平、CD4^(+)T/CD8^(+)T值较低危、中危组显著降低,PD-1、CD8^(+)T显著升高(P<0.05)。死亡组补体C3、IgA、IgG、IgM、IFN-γ、CD4^(+)T水平、CD4^(+)T/CD8^(+)T值较存活组显著降低,PD-1、CD8^(+)T显著升高(P<0.05)。ROC曲线分析显示,免疫因子、T淋巴细胞亚群联合预测脓毒症患者免疫调理治疗后病情改善的AUC为0.923,灵敏度为89.90%、特异度为82.31%,预�Objective:To investigate the guiding significance of monitoring of immune factors and T lymphocyte subsets in immunomodulatory treatment of sepsis.Methods:Eighty patients with sepsis admitted to Nangyang First People's Hospital from June 2022 to December 2023 were selected as sepsis group,and 80 healthy volunteers who underwent physical examination during the same period were selected as health group.Detection of immune factors[complement C3,IgA,IgG,IgM,IFN-γ,programmed cell death receptor-1(PD-1)]and T lymphocyte subsets(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))on the day of physical examination in healthy group,the day after sepsis group was enrolled,before treatment,and on day 1,3,and 7 after treatment,expressions of immune factors and T lymphocyte subsets were compared between the two groups.All 80 patients with sepsis received comprehensive treatment,during which thymosine-α1 was added for immunoconditioning treatment.Patients were divided into groups according to the improvement of their condition after immunoconditioning treatment[low-risk group(n=31),medium-risk group(n=34),high-risk group(n=15)]and disease outcome[survival group(n=55)and death group(n=25)].To analyze the efficacy of immune factors and T lymphocyte subsets in predicting the condition improvement and disease outcome of patients with sepsis after immune conditioning treatment.Results:Compared with healthy group,expression levels of immune factor complements C3,IgA,IgG,IgM and IFN-γin sepsis group were decreased,relative expression level of PD-1 mRNA was increased,the values of CD4^(+)T and CD4^(+)T/CD8^(+)T of T lymphocyte subsets were decreased,while CD8^(+)T was increased(P<0.05).Compared with before treatment and 1 day after treatment,expression levels of complements C3,IgA,IgG,IgM,IFN-γ,CD4^(+)T and CD4^(+)T/CD8^(+)T of T lymphocyte subsets were significantly increased in patients with sepsis after treatment on 3 and 7 days,while the relative expression level of PD-1 mRNA and CD8^(+)T were significantly decreased(P<0.05).Condition of sepsis

关 键 词：脓毒症 免疫调理 免疫因子 T淋巴细胞亚群 

分 类 号：R631[医药卫生—外科学]