脓毒症相关急性呼吸窘迫综合征患者T淋巴细胞免疫功能状态研究  

Research on the immune function status of T lymphocytes in patients with sepsis-related acute respiratory distress syndrome

作　　者：曾小良[1] 王江伟[1] 玉佳宁 禤懿璇 钟迎 冯基花 谢昊珉 张剑锋 Zeng Xiao-liang;Wang Jiang-wei;Yu Jia-ning;Xuan Yi-xuan;Zhong Ying;Feng Ji-hua;Xie Hao-min;Zhang Jian-feng(Department of Preventive Medicine Outpatient,Guangxi Center for Disease Control and Prevention,Nanning,Guangxi 530028,China;Department of Emergency,Wuming Hospital of Guangxi Medical University,Nanning,Guangxi 530199,China;Department of Emergency,The Second Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530007,China)

机构地区：[1]广西壮族自治区疾病预防控制中心预防医学门诊部,广西南宁530028 [2]广西医科大学附属武鸣医院急诊科,广西南宁530199 [3]广西医科大学第二附属医院急诊科,广西南宁530007

出　　处：《中国现代医学杂志》2025年第3期55-62,共8页China Journal of Modern Medicine

基　　金：广西医疗卫生适宜技术开发与推广应用项目(No:S2021063);国家自然科学基金(No:82360374);广西重点研发计划项目(No:桂科AB23026012);广西壮族自治区卫生健康委员会重点(培育)实验室建设任务书(No:ZPZH2020002);广西壮族自治区卫生健康委员会自筹经费科研课题(No:Z20211102)。

摘　　要：目的 探讨脓毒症相关急性呼吸窘迫综合征(ARDS)患者T淋巴细胞亚群、CD4^(+)T淋巴细胞共信号 CD28 和 CTLA-4 表达。方法 选取 2022 年 3 月—2022 年 11 月广西医科大学第二附属医院收治的 22 例脓毒症相关ARDS患者作为病例组,另选取同期该院21例健康志愿者作为对照组。收集所有受试者临床资料;病例组行全身全身感染相关性器官功能衰竭评价系统评分、急性生理学和慢性健康状况评价Ⅱ评分、多器官功能障碍综合征评分、Murray肺损伤评分及早期肺损伤评分;采用流式细胞术检测外周全血及外周血单个核细胞。结果 与对照组比较,病例组CD45^(+)、CD3^(+)、CD4^(+)、CD8^(+)T 淋巴细胞计数均减少(P <0.05);CD3^(+)、CD4^(+)、CD8^(+)T 淋巴细胞在 CD45^(+)细胞表达的百分比均降低(P <0.05)。与对照组比较,病例组 Th17 和 Treg 细胞在CD4^(+)T淋巴细胞表达的百分比均升高(P <0.05)。与对照组相比,病例组CD28在CD4^(+)T淋巴细胞表达的百分比降低(P <0.05),病例组CTLA-4在CD4^(+)T淋巴细胞表达的百分比升高(P <0.05)。结论 脓毒症相关ARDS患者T淋巴细胞显著减少,CD4^(+)T淋巴细胞分化异常,CD4^(+)T淋巴细胞共信号CD28和CTLA-4表达失调,提示T淋巴细胞在脓毒症相关ARDS免疫调节中发挥重要作用。Objective To investigate the T lymphocyte subsets,co-stimulatory molecules CD28 and CTLA-4expression in CD4~+ T lymphocytes in patients with sepsis-related acute respiratory distress syndrome (ARDS).Methods A total of 22 patients with sepsis-related ARDS admitted to the Second Affiliated Hospital of Guangxi Medical University from March 2022 to November 2022 were selected as the case group,while 21 healthy volunteers from the same hospital during the same period were recruited as the control group.The case group underwent various scoring assessments,including the systemic infection-related organ failure assessment,acute physiology and chronic health evaluation Ⅱ,multiple organ dysfunction syndrome,Murray lung injury score,and early lung injury score.Peripheral whole blood and peripheral blood mononuclear cells were analyzed with flow cytometry.Results Compared with the control group,the case group showed significant reductions in CD45~+,CD3~+,CD4~+,and CD8~+ T lymphocyte counts (P <0.05).The percentages of CD3~+,CD4~+,and CD8~+ T lymphocytes among CD45~+ cells were also decreased in the case group (P <0.05).In contrast,the percentages of Th17 and Treg cells among CD4~+ T lymphocytes were increased in the case group (P <0.05).Additionally,the percentage of CD28expression in CD4~+ T lymphocytes was lower in the case group (P <0.05),while the percentage of CTLA-4expression in CD4~+ T lymphocytes was higher compared to the control group (P <0.05).Conclusions Patients with sepsis-related ARDS exhibit significant reductions in T lymphocyte counts,abnormal differentiation of CD4~+ T lymphocytes,and dysregulated co-stimulatory molecule expression of CD28 and CTLA-4 in CD4~+ T lymphocytes.These findings suggest that T lymphocytes play a critical role in immune regulation in sepsis-related ARDS.

关 键 词：脓毒症 急性呼吸窘迫综合征 免疫功能 T淋巴细胞 

分 类 号：R563.8[医药卫生—呼吸系统] R459.7[医药卫生—内科学]