脓毒症患者外周血T淋巴细胞亚群变化及临床意义

Alterations of peripheral blood T cell subsets in patients with sepsis and the clinical implications

目的观察脓毒症患者外周血T淋巴细胞亚群水平变化,探讨脓毒症患者外周血T淋巴细胞亚群在发病中作用及预后意义。方法以温州医学院附属第二医院急救中心及急诊ICU2007年8月～2009年7月收治的脓毒症患者64例为研究对象,采用流式细胞仪检测64例脓毒症患者(脓毒症组)入院后第1、7、14天外周血CD3+、CD4+、CD8+T淋巴细胞计数,并按病情好转与未好转分为两组,比较两组的异同。同时以同期20例健康体检者作为健康对照组。结果 2组脓毒症患者第1天CD3+、CD4+T淋巴细胞计数及CD4+/CD8+T淋巴细胞计数比值均明显低于健康对照组(P<0.05),CD8+T淋巴细胞计数比较无明显统计学差异;2组脓毒症患者之间第1天CD3+、CD4+T淋巴细胞计数及CD4+/CD8+T淋巴细胞计数比值存在统计学差异,未好转组明显低于好转组(P<0.05);好转组CD3+、CD4+T淋巴细胞计数及CD4+/CD8+T淋巴细胞计数比值随着治疗时间变化逐渐得到纠正,在第14天时接近健康对照组(P>0.05)。未好转组无明显改变。结论脓毒症患者可以出现免疫失衡,表现为CD3+、CD4+、CD4+/CD8+比值的下降,且其和疾病严重程度存在一定相关性。CD3+、CD4+、CD4+/CD8+比值可以作为脓毒症治疗过程中的疾病严重程度的检测指标。

Objective To observe the dynamic changes of CD3＋,CD4＋,and CD8＋ T lymphocytes in the peripheral blood of patients with sepsis and discuss the clinical significance.Methods Sixty-fourpatients admitted in the Emergency Centerand Emergency Intensive Care Unit of the Second Hospital of Wenzhou Medical University between August,2007 and July,2009 were enrolled in this study.CD3＋,CD4＋,and CD8＋ T lymphocytes in the peripheral blood were detected by flow cytemetry on days 1,7 and 14 after admission,and the results were compared between the patients with improvement of the condition and those without improvement,with 20 healthy subjects as the control group.Result On day 1 afteradmission,CD3＋ and CD4＋ T lymphocytes and CD4＋/CD8＋ T cell ratio were obviously lowerin the 2 groups of patients with sepsis than in the control group（P0.05）,but no significant difference was found in CD8＋ T lymphocytes.The sepsis patients with clinical improvement showed significant higher CD3＋ and CD4＋ T lymphocyte percentages and CD4＋/CD8＋ T cell ratio than those without improvement on day 1.In the patients with clinical improvement,CD3＋ and CD4＋T lymphocytes and CD4＋/CD8＋ T cell ratio increased gradually with time and till day 14,they were comparable with the control levels;in the patients without improvement,CD3＋ and CD4＋ T lymphocytes and CD4＋/CD8＋ T cell ratio showed no obvious alterations in the course of observation.Conclusion Immune imbalance occurs in patients with sepsis represented by lowered CD3＋ and CD4＋T lymphocyte percentages and CD4＋/CD8＋ T cell ratio in relation to the severity of the condition.CD3＋ and CD4＋ T lymphocytes and CD4＋/CD8＋ T cell ratio can be used as the indicators forassessing the severity of sepsis.