重症急性胰腺炎Fas表达、淋巴细胞凋亡及与并发脓毒症的关系

Correlation of Fas expression and apoptosis of lymphocytes with occurrence of sepsis in patients with severe acute pancreatitis

目的:研究重症急性胰腺炎(severe acutepancreatitis,SAP)患者外周血淋巴细胞Fas表达、淋巴细胞凋亡与并发脓毒症的关系.方法:流式细胞术检测18例SAP患者(10例并发脓毒症,8例为非脓毒症)及20例轻症胰腺炎(mild acute pancreatitis,MAP)患者外周血淋巴细胞Fas表达、淋巴细胞凋亡,ELISA检测血清可溶性Fas(soluble Fas,sFas)水平,以20例同期健康体检者作为正常对照.结果:(1)与MAP及正常对照组相比,SAP组外周血淋巴细胞Fas表达、淋巴细胞凋亡率及血清sFas水平明显升高(均P<0.01),并发脓毒症者升高更为显著(38.37%±4.33%vs26.34%±2.65%,13.45%±2.99%vs6.33%±2.05%,9.89ng/mL±1.25ng/mLvs7.36ng/mL±0.95ng/mL,均P<0.01);(2)MAP组外周血淋巴细胞Fas表达、淋巴细胞凋亡率及血清sFas水平较正常对照组轻度升高,差异无显著性;(3)SAP脓毒症患者外周血淋巴细胞Fas表达与淋巴细胞凋亡呈正相关(r=0.988,P<0.01).结论:Fas信号通道介导的淋巴细胞凋亡与胰腺炎病情的严重程度密切相关,可能由于淋巴细胞过度凋亡引起免疫抑制,导致了SAP脓毒症的发生和发展.

AIM：To investigate Fas expression and apoptosis of lymphocytes in severe acute pancreatitis（SAP） patients with and without sepsis.METHODS：Fas expression and apoptosis of lymphocytes were examined by flow cytometry.Serum soluble Fas（sFas） levels were measured by enzyme-linked immunosorbent assay（ELISA） in 18 SAP patients（10 cases with sepsis,8 cases without sepsis）,20 patients with mild acute pancreatitis（MAP）,and 20 healthy volunteers（control）.RESULTS：Compared to the MAP and control groups,Fas expression,apoptosis of lymphocytes,and serum sFas levels increased significantly in the SAP group（all P 0.01）,and these changes were more significant in SAP patients with sepsis than in those without sepsis（38.37% ± 4.33% vs 26.34% ± 2.65%,13.45% ± 2.99% vs 6.33% ± 2.05%,9.89 ng/mL ± 1.25 ng/mL vs 7.36 ng/mL ± 0.95 ng/mL,all P 0.01）.There was no significant difference in Fas expression,apoptosis of lymphocytes,and serum sFas levels between the normal control group and MAP group.A significant positive relationship was observed between Fas expression and apoptosis of lymphocytes in SAP patients with sepsis（r = 0.988,P 0.01）.CONCLUSION：The Fas signaling pathway may be involved in apoptosis of lymphocytes and is closely related to the severity of pancreatitis.Excessive apoptosis of lymphocytes appears to be related to immunosuppression and thereby results in the occurrence and development of sepsis in SAP patients.