Th17／Treg及其相关炎症介质在重症脓毒症中表达失衡的临床研究

Clinical study on the disequilibrium of Th17/Treg and their related inflammatory mediator in severe sepsis

目的探讨Th17／Treg（CD4、CD25Treg）及其相关炎症介质白细胞介素（IL）-17、IL-6、IL-10表达失衡在重症脓毒症发病中的作用。方法选择2010—01～2010—10人住我院ICU的重症脓毒症患者60例，其中脓毒性休克23例，非休克37例；健康对照组30例。采用流式细胞术（FCM）检测各组外周血Treg及Th17表达率。应用酶联免疫吸附试验（ELISA）检测各组外周血IL-17、IL-6、IL-10水平。结果重症脓毒症患者外周血中Treg、Th17表达率及IL-17、IL-6、IL-10水平显著高于对照组（P〈0．01）。脓毒性休克组Treg表达率及IL-17、IL-6、IL-10水平显著高于非休克组（P〈0．01），Th17表达率、Th17／Treg、IL-17／IL-10及IL-6／IL-10显著低于非休克组（P〈0．01）。Treg表达率与急性生理和慢性健康状况评分lI（APACHE1I）呈正相关（r：0．87，P〈0．01）。Th17表达率与APACHEⅡ评分无相关性。结论Treg、Th17及其相关炎症介质在重症脓毒症的发病过程中起重要作用。脓毒性休克及非休克患者体内均存在强烈的促炎和抗炎反应，Treg可能抗炎反应更为强烈，而Th17可能促炎反应更为强烈。

Objective To investigate the significance of Thl7/Treg and their associated cytokines IL - 17, IL - 6 and IL - 10 in the patients with severe sepsis. Methods 60 severe septic patients including 37 non - septic shock patients and 23 septic shock patients admitted to ICU of our hospital in January to October 2010 were enrolled, and 30 healthy volunteers were served as control group. The percentage of Treg and Thl7 in peripheral blood was detected by flow cytometry analysis. Concentrations of related plasma cytokines including IL - 17, IL - 6 and IL - 10 were measured by enzyme - linked immunosorbent assay. Results The expression rate of Treg, Thl7and the level of IL - 17, IL -6 and IL - 10 were significantly higher in the patients with severe sepsis than in normal control group（P 〈 O. O1 ）. The expression rate of Treg and the level of IL - 17, IL - 6 and IL - 10 were significantly higher in the patients with sepsis shock than in no - shock sepsis group （ P 〈 O. 01 ）. The expression rate of Thl7 and the ratio of Thl7/Treg, IL- 17/IL- 10 and IL- 6/IL- 10 were significant lower in the patients with sepsis shock than in no - shock sepsis （ P 〈 0.01 ）. There was positive relationship between the expression rate of Treg and scores of APACHE lI （ r = 0.87, P 〈 0.01 ）. There was no relationship between expression rate of Thl7 and scores of APACHE lI. Conclusion There is apparent growth and disequilibrium of the expression rate of Treg, Thl7 and their associated cytokines in the patients with severe sepsis. Maybe they act important role in the pathogenesis of severe sepsis. There was intensive inflammatory and anti - inflammatory reaction in the patients with septic shock and no - septic shock. It seems that anti - inflammatory reaction predominated in the former and inflammatory reaction predominated in the latter.