摘要
目的明确严重烧伤后患者外周血T淋巴细胞免疫功能的变化规律,并探讨其在患者不良预后中的临床意义。方法对106例烧伤总体表面积(TBSA)≥30%的患者进行动态观察,对所采集临床病例资料进行分析。试验分组:(1)按烧伤面积将患者分为3组:Ⅰ组41例(TBSA 30%~49%),Ⅱ组34例(TBSA 50%~69%),Ⅲ组31例(TBSA 70%~99%);(2)将59例并发脓毒症患者根据其预后分为死亡组(17例)与存活组(42例)。同时设正常对照组(25位健康献血员)。分别于烧伤后1、3、7、14、21天采集患者外周静脉血,分离外周血T淋巴细胞,分别检测T淋巴细胞增殖活性和T淋巴细胞孵育上清中白细胞介素(IL)-2分泌水平等。结果与正常对照组比较,严重烧伤患者各烧伤面积组外周血T淋巴细增殖活性及IL-2表达水平均明显降低,Ⅰ组与Ⅲ组比较存在显著差异(P<0.01)。死亡组患者T淋巴细胞增殖活性及IL-2表达水平在伤后3~21天明显低于存活组(P<0.01或P<0.05)。结论严重烧伤后T淋巴细胞免疫功能明显受抑,机体免疫功能障碍程度与烧伤面积和患者预后密切相关。
Objective To observe the changes in T lymphocyte-mediated immunity in severely burned patients,and to investigate their relationship with patients' prognosis.Methods One hundred and six patients with total burn surface area(TBSA) larger than 30% were included in the present study,and they were divided into three burn size groups: 30%-49% TBSA(group Ⅰ,n=41),50%-69% TBSA(group Ⅱ,n=34),and 70% TBSA(group Ⅲ,n=31).According to the definition of sepsis in burns,59 patients were developed into septic complications,then the septic patients were further divided into non-survival group(n=17) and survival group(n=42).Healthy volunteers served as normal controls(n=25).The periphery blood samples were collected on postburn day(PBD) 1,3,7,14,and 21,respectively.The blood samples were used to isolate T cells,and T cell proliferation assay was performed by thiazolyl blue,and interleukin(IL)-2 released into supernatants were determined by ELISA kits for human after culturing the T cells.Results The T cell proliferative activity in response to phytohemagglutinine and protein levels of IL-2 in supernatants in burn-injured patients were significantly suppressed on PBD 1-21 compared with normal controls,and there were obvious differences in both T cell proliferative activity and IL-2 release between group Ⅰ and group Ⅲ(P0.01).Among septic patients,the T cell proliferative activity in response to phytohemagglutinine and IL-2 release in the survival group were markedly higher than those with fatal outcome on PBD 3-21(P0.01 or P0.05).Conclusion Suppression of T lymphocyte immune function is induced by severe burn injury.The immunosuppressive state of T lymphocytes is related to the extent of burn injury and poor outcome in burned patients.
出处
《创伤外科杂志》
2010年第4期310-313,共4页
Journal of Traumatic Surgery
基金
国家自然科学基金(30872683
30901561)
国家重点基础研究发展规划项目(2005CB522602)资助