脓毒症及脓毒性休克患儿的免疫功能变化的研究

The Clinical Study of Cellular Immunity and Humoral Immunity in Children with Sepsis or Septic Shock

目的:探讨脓毒症及脓毒性休克患儿各免疫指标的变化以及对疾病预后的影响。方法:18例脓毒症及36例严重脓毒症患儿于发病3d、7d分别检测T淋巴细胞亚群(CD3+,CD4+,CD8+,CD19+)和IgG、IgA、IgM,同时记录生命体征的变化和预后转归,其中死亡病例5例归入死亡组。同期19名健康体检儿童为健康对照组。结果:脓毒症组发病3d内的CD4+、CD19+T淋巴细胞亚群计数较正常组和严重脓毒症组明显升高,两组比较有统计学意义(P<0.05)。IgG、IgA、IgM在发病3d内各组水平比较无统计学意义。发病7d复测T淋巴细胞亚群和体液免疫功能,死亡组CD3+、CD4+、CD8+、IgG、IgA均明显低于存活组,差值比较有统计学意义(P<0.05或P<0.01)。结论:脓毒症的免疫状态在疾病的不同阶段表现不同,随着病情进展免疫抑制状态持续并恶化预示了疾病预后不良。

Objective：To investigate the changes of all kinds of immune indexes and the effect to the prognosis in children with sepsis or septic shock. Methods：54 cases including 18 septic children and 36 severe septic children were detected the count of T lymphocyte subpopulations （CD3 ＋ ,CD4 ＋ ,CD8 ＋ ,CD19 ＋ ） and immunogiobulin G,A,M, and also recorded the change of vi- tal sign and prognosis. In these cases, 5 patients were died. 19 healthy children were enrolled in this study as control group. Result;The count of T lymphocyte CD4 ＋ , CD19 ＋ in sepsis group within disease onset 3 days were significantly higher than that of control group and severe sepsis group （P〈0.05）, the change of Ig G, IgA, IgM within disease onset 3days were not statistically significant among sepsis group, severe sepsis group and control group. The count of CD3 ＋ ,CD4 ＋ ,CD8 ＋ ,IgG, IgA were detected significant lower in dying group at disease 7day than that of survival group （P〈0.05）. Conclusion： The im- mune state of sepsis is different at different disease stage. With sepsis progressing and deteriorating, the immune state appears suppressive , which prognosticating the bad outcome of disease.