大面积烧伤脓毒症患者T淋巴细胞免疫功能的改变及临床意义

The clinical significance of changes in immunological function of T lymphocyte in severe bum patients with sepsis

目的 了解大面积烧伤脓毒症患者T淋巴细胞免疫功能的变化，探讨其与脓毒症的关系。方法 选择59例烧伤面积≥30％TBSA的患者，分为脓毒症组43例和非脓毒症组16例。采集两组患者伤后1、3、5、7、14、21、28d的外周静脉血，检测T淋巴细胞增殖能力和白细胞介素2（IL-2）的分泌水平，并行相关性分析；通过流式细胞仪检测CD3^＋／CD4^＋ T淋巴细胞的百分率及其凋亡率，并行相关性分析。结果 与非脓毒症组比较，脓毒症组患者伤后l、14、2l、28dT淋巴细胞增殖能力和IL-2的分泌水平均显著下降（P〈0．05或P〈0.01），两指标呈显著正相关（r=0．82，P〈0．01）。伤后1、5、14、21、28d，脓毒症组患者CD3^＋／CD4^＋T淋巴细胞百分率明显低于非脓毒症组，而其凋亡率呈相反趋势（P〈0.05或P〈0．01），两指标呈显著负相关（r=-0.66，P〈0．05）。结论 大面积烧伤脓毒症患者T淋巴细胞免疫功能持续处于抑制状态，T淋巴细胞凋亡参与了脓毒症细胞免疫紊乱的病理生理过程。

Objective To observe the immunological function changes in T lymphocyte in severe burn patients with sepsis, and to explore its relationship with sepsis. Methods Fifty-nine burn patients with burn surface exceeding 30% TBSA were enrolled in the study, and they were divided into sepsis group （S, n =43） and non-sepsis group （NS,n = 16）. The peripheral venous blood samples of the patients in both groups were collected on 1, 3, 5, 7, 14, 21 and 28 post-burn days （ PBD）. The T lymphocyte proliferation ability and the interleukin-2 （IL-2） level in both groups were observed and the correlation between them were analyzed. The percentage of CD3^＋/ CD4^＋ T lymphocytes and its apoptosis rate were determined by flow cytometry and the correlation between them was analyzed. Results Compared with that in NS group, the proliferation ability of T lymphocyte and the level of IL-2 were significantly decreased in patients in S group on 1, 14, 21, and 28 PBD（ P 〈 0.05 or P 〈 0.01 ）. The inhibition of T lymphocyte proliferation was positively correlated to the low level of IL-2 production in burn patients （ r = 0.82, P 〈 0.01 ）. The percentage of CD3^＋/CD4 ^＋ T lymphocytes in S group were obviously lower than that in NS group on 1, 5, 14, 21, 28 PBD, whereas on opposite tendency in the apoptosis rate of CD3^＋ CD4^＋ T lymphocytes were found at the same time （ P 〈 0.05 or P 〈 0.01 ）. The percentage of CD3^＋/CD4^＋ T lymphocytes was negatively correlated to apoptosis rate of T lymphocytes （ r = - 0.66, P 〈 0.05 ）. Conclusion The immunological function of T lymphocyte in severely bum patients with sepsis is depressed persistently. Apoptosis of T lymphocyte may participate in the pathological process of cell immunological disorder induced by sepsis.