免疫调理治疗对脓毒症患者血CD4＋CD25＋T细胞的影响

The Effect of immunomodulatory therapy On CD4 ＋ CD25 ＋ tregs in peripheral blood of patients withSepsis

目的了解脓毒症患者外周血调节性T细胞（CIM＋CD25＋Tregs）比例水平及其与机体细胞免疫之间的关系，并探讨免疫调理治疗对其水平的影响。方法选择滕州市中心人民医院住院治疗的脓毒症患者40例，随机分成治疗组和对照组，治疗组加用乌司他丁和胸腺肽α1作抗炎和免疫调节治疗，分别于治疗前和治疗后第3，第8天抽外周静脉血，检测T淋巴细胞亚群、CD4＋CD25＋Tregs，TNF-α，IL-6，IL-10水平，同时APACHE Ⅱ评分。结果治疗前两组患者CD4＋CD25＋Tregs细胞水平明显升高，总淋巴细胞数、T细胞比例下降，其中以CD4＋T细胞下降更明显，CD4＋／CD8＋明显下降，IL-6，TNF-α水平升高；治疗后，两组患者CD4＋CD25＋Tregs降低，总淋巴细胞数、CD4＋／CD8＋比值升高，APACHEII评分和IL-6，TNF-α水平均下降，治疗组改善更明显。结论外周血CD4＋CD25＋Tregs细胞比例水平，可以作为评价机体免疫能力及预后新指标；联合应用胸腺肽α1和乌司他丁治疗脓毒症，可提高患者免疫力，显著降低APACHEⅡ评分、IL-6，TNF-α水平，改善患者病情。

Objective To investigate the percentage of CD4 ＋ CD25＋ Tregs in peripheral blood of patients with sepsis and its effect on cell immunity so as to unravel the effect of immunomodulatory therapy on it. Method Fourty patients with sepsis in ICU were randomly （random number） divided into experimental group and control group . The patients of experimental group were treated with Ulinastatin and immunoregulation agent （Thymosin ctl ） as well. The blood specimens were collected just before treatment, 3 days and 8 days after treatment. The percentages of CD4 ＋ CD25 ＋ Tregs and lymphocyte subsets were detected by using FCM （flow cytometry）, and TNF-α, IL-6 and IL-10 assayed by using ELISA, and APACHE l] scores were calculated. Results Before treatment, the percentage of CD4 ＋CD25 ＋ Tregs increased, and the number of lymphoeytes and the percentage of T lymphoeytes decreased, especially the CD4 ＋ Tdympboeytes and CD4 ＋/CD8 ＋ decreased more markedly, and the levels of IL-6 and TNF-α increased. After treatment, the percentage of CD4＋ CD25 ＋ Tregs was decreased, the number of lymphocytes and CD4 ＋/CD8 ＋ increased, and the levels of APACHE 11 score, IL-6 and TNF-α decreased especially in the experimental group decreased more significantly （ P 〈 0.05 ）. Conclusions The percentage of CD4＋ CD25 ＋ Tregs in peripheral blood can reflect the immune status of patients with sepsis and become a novel indicator to estimate the progress of sepsis, and the immunity and prognosis of patients. Treating the patients with Thymosin α and Ulinastatin can raise their immunity, decrease the levels of IL-6, TNF-α and APACHE Ⅱ score and improve their prognosis.