腹部重症脓毒症老年患者术后T淋巴细胞亚群的变化

Dynamic changes and clinical meanings of T lymphocytes in severe sepsis postoperative patients

目的探讨重症脓毒症患者免疫治疗及各免疫指标的变化对严重脓毒症患者预后的影响。方法将20例腹部无明显感染的患者、20例腹部脓毒症患者不伴器官功能障碍、18例腹部严重脓毒症及脓毒性休克患者分为A、B、C组,A组术前及A、B、C组术后第1、3、7天,各抽取外周静脉血5ml于肝素管内,分别测定T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)。同时记录生命体征的变化和预后转归。结果A、B、C三组在术后1、3天,CD3、CD4、CD4/CD8均下降,C组下降明显,与A、B组比较,差异具有显著性意义(P<0.05),术后第7天A、B、C组(病情好转者)均上升,C组恶化者CD3、CD4、CD4/CD8持续低下,与A、B、C组(病情好转者)比较,差异具有显著性意义(P<0.05)。结论手术对T淋巴细胞CD3、CD4抑制明显,术后1、3天抑制明显,7天明显上升至正常。对于术后脓毒症不伴器官功能障碍者对T淋巴细胞亚群影响不大,其变化与手术对机体免疫功能的变化一致。对于术后重症脓毒症及脓毒性休克患者IgA、IgM、IgG,C3、C4及T淋巴细胞亚群CD3、CD4、CD4/CD8明显降低,且随病情恶化,持续在较低水平。

Objective To observe the dynamic state diversify of the immune function in serious sepsis patients and the effect to the prognosis of patients with the changes of all kinds of immune indexes. Methods 58 cases were divided into 3 groups：A, B, C. Among them, A group was 20 patients without obvious infection in their abdomens,B group 20 patients were infected with serious sepsis,but no organ dysfunetion,C group 18 patients with serious sepsis and septic shock. 5ml peripheral blood was withdrawn in A group preoperative and put into a common tube and a heparin tube.5ml blood was withdrawn in 1, 3,Tdays in A, B, C groups post-operation, then putting into the common tubes and the heparin tubes. The peripheral T lymphocyte subsets CD3,CD4,CD4/CD8 were measured. Results Compared with the preoperative level, CD3,CD4,CD4/CD8 in the first and third day in group A were lower obviously and showed significant difference （P〈0.05）. On the seventh day , CD3,CD4 went up and there was not significant difference with the preoperative level （P〉0.05）. On the first, third day after operation, CD3,CD4, CD4/CD8 in group A and group B subsided and those went up abruptly in the seventh day,there was not significant difference between group A and group B at the same time（P〉0.05）.But those in group C subsided obviously on the first, third and seventh day ,compared with their level in groupA,B there was significant difference（P〈0.05）. Conclusion Operation obviously inhibits CD4,CD4/CD8. On first and third day after operation, those elements go up obviously. As to the patients in serious sepsis and septic shock CD3,CD4 and CD4/CD8 subside obviously.With deterioration of patient＇s condition, those elements will keep low. If patients turn to be good ,the condition may be opposition.