摘要
目的:探讨脓毒症患者CD4+CD25+调节性T细胞(Treg)的水平和意义以及脉冲高容量血液滤过(PHVHF)对它们的影响。方法:将2008年1月~2010年11月在安徽省立医院ICU住院的脓毒症患者40例按照疾病严重程度分为3组:脓毒症组14例,严重脓毒症组15例,脓毒症休克组11例。其中行PHVHF患者25例。40例脓毒症患者在入选当天和d5行流式细胞术检测血中CD4+CD25+Treg细胞的比例和CD3+、CD4+、CD8+和CD4+/CD8+水平。同时选取20例健康人为对照组。结果:健康对照组CD4+CD25+Treg细胞表达率为(0.39±0.23%);脓毒症组为(1.72±0.59%);严重脓毒症组(2.72±0.22%);脓毒性休克组(3.55±0.51%),后3组间两两比较有显著性差异(均P<0.05)。脓毒症组CD3+、CD4+和CD4+/CD8+较正常对照组显著升高(P<0.05)。严重脓毒症组和脓毒症休克患者CD3+、CD4+、CD4+/CD8+较正常对照组显著降低(均P<0.05)。与死亡组比较,生存组PHVHF能更有效地降低CD4+CD25+Treg细胞的异常表达(P<0.05),上调CD3+、CD4+、CD8+和CD4+/CD8+水平。结论:CD4+CD25+Treg细胞在脓毒症的免疫发病机制中可能起着重要作用,随病情加重,免疫抑制加强。PHVHF可调整脓毒症患者T细胞亚群比例,改善其免疫抑制状态,可作为脓毒症免疫调节治疗的手段之一。
Objective:To study the level and significance of CD4^+CD25+ Treg cells and CD3^+,CD4^+,CD^8+ cells in peripheral blood of patients with sepsis and evaluate the effects of pulse high volume hemofiltration(PHVHF)on them.Methods:Forty patients with sepsis in ICU of Anhui Provicial Hospital were studied from January 2008 to November 2010.Patients were divided into three groups:sepsis group(n=14),severe sepsis group(n=15)and septic shock group(n=11).The expressions of CD4^+CD25+ Treg cells and CD3^+,CD4^+,CD^8+ cells of 40 patients on the day 1 and day 5 were detected by flow cytometry and were compared.Twenty five patients receiving PHVHF were divided into two groups:death group(n=7)and survive group(n=18).Twenty healthy individuals served as controls.Results:The expressions of CD4^+CD25+ Treg cells were the highest in septic shock group(3.55±0.51%),followed by the severe sepsis group(2.72±0.22%) and the sepsis group(1.72±0.59%).There were significant differences among the three groups(all P〈0.05).The level of CD3^+,CD4^+ and CD4^+/CD^8+ in sepsis group was higher than control group(P〈0.05)and the level of CD3^+、CD4^+ and CD4^+/CD^8+ in severe sepsis and sepsis shock were lower than control group(P〈0.05).Compared with death group,PHVHF could decrease the abnormal expression of CD4^+CD25+ Treg cells and increase the level of CD3^+,CD4^+ and CD4^+/CD^8+ in survive group.Conclusion:CD4^+CD25+ Treg cells may play an important role in pathogenesis of sepsis.PHVHF could rebuild immunologic balance and to be used in the treatment of sepsis patients.
出处
《中日友好医院学报》
2011年第2期87-91,共5页
Journal of China-Japan Friendship Hospital
基金
安徽省卫生厅课题(09A079)