严重创伤后早期血液CD4＋T细胞及其细胞因子的变化

Early changes of peripheral blood CD4 T cells and the related cytokines in patients with severe trauma

目的探讨创伤后早期患者血液中CD4＋T细胞及其细胞因子的变化趋势。方法连续人选2009年9月至2011年11月在解放军第九七医院住院的61例成年男性创伤患者。排除标准：①年龄小于18岁或大于75岁者。②伤后已输血者。③患有免疫系统疾病，肿瘤，糖尿病，近期有病毒、细菌、寄生虫感染病史者。④正在或近期使用免疫抑制剂、激素等药物者。以损伤严重度评分≥16分为严重损伤标准，将患者分成轻伤组和重伤组两组。17例健康成人男性血样标本作为正常对照组。在入院当时抽取患者静脉血，采用流式细胞术检测外周血中CD3＋、CD4＋、CD8＋T细胞含量，采用酶联免疫吸附法检测血浆中TNF-a、INF．1、IL-1、IL4、IL-6及IL-12水平，并计算Thl／Th2型细胞因子比值。使用SPSS16．0统计软件进行统计学处理，两组间比较采用t检验，多组比较采用方差分析或秩和检验。以P〈0．05为差异具有统计学意义。结果重伤组与轻伤组患者血液中CD3＋T细胞含量均降低，重伤组CIM＋T细胞含量明显降低；INF-1在重伤组明显低于对照组；IL-1在两组中均降低；INF-1／IL-6重伤组明显低于轻伤组，而轻伤组明显高于对照组。结论严重创伤后早期患者血液中CD3＋、CD4＋T细胞明显下降，伴随有多种细胞因子的明显降低；严重创伤早期存在向Th2型细胞因子偏移的趋势。因此，严重创伤后应早期动态监测患者血液中免疫细胞的变化。

Objective To investigate the early changes of CD4 ＋ T cells and the relevant cytokines in blood of patients with severe trauma. Methods Sixty-one consecutive patients with trauma admitted into the 97th Hospital of PLA from September 2009 to November 2011 were enrolled in this study. The exclusion criteria included： Patients were younger than 18 or older than 75 years. Patients received blood transfusion. Those suffered from immune system disorders, tumors or diabetes, or recent history of virus, bacteria or parasites infections. Those had current or recent treatment with corticosteroids or immunosuppressive drugs. According to ISS score I〉 16, there were 61 traumatic patients divided into mild trauma group and severe trauma group. Seventeen healthy volunteers were taken as control subjects. At admission, the peripheral venous blood samples of patients were taken to count the number of CD3 ＋ , CIM ＋ , CD8 ＋ T cells by flow cytometry and to detect TNF-a, INF-y, IL-1, IL-4, IL-6 and IL-12 levels in plasma by enzyme linked immunosorbent assay, meanwhile the ratio of Thl / Th2 type cytokine were calculated. Data were analyzed with t test and ANOVA or Kruskal-WalIis test by using SPSS version 16.0package. P value 〈 0.05 was considered to be statistical significance. Results Compared with control group, mild trauma and severe trauma groups showed a similar decrease in number of CD3 T cells, and severe trauma group showed a most significant decrease in number of CD4 T cells. Severe trauma group had a lower INF-Y level compared with control group; IL-1 level in both mild trauma and severe trauma groups were lower than that in the control group; INF-Y IL-6 in severe group was significantly lower than that in the mild group. However, INF-Y IL-6 in mild group was higher than that in the control group. Conclusions The early stage of severe trauma exhibits a significant decrease in number of both CD3 ＋ and CIM T ceils, accompanied by a significant reduction in most of cytokines, and has a tendency of shift to Th2 type cytokine. Therefore, the changes of immune cells should be promptly and successively monitored after severe trauma.