重症急性胰腺炎患者早期免疫功能的变化及临床意义

Changes of immune function of patients with severe acute pancreatitis in early stage and their clinical significance

目的探讨重症急性胰腺炎(SAP)患者早期免疫功能的变化趋势及临床意义。方法采用酶联免疫吸附测定(ELISA)法检测42例SAP患者不同时间血浆C反应蛋白(CRP)、IgG、IgM、IgA、C3、C4、肿瘤坏死因子α(TNF-α)及白细胞介素-10(IL-10);采用流式细胞仪检测其血浆CD3+、CD4+和CD8+T淋巴细胞亚群的分布情况。结果 SAP患者血浆CRP水平具有先升后降的趋势,而血浆IgG和IgM水平的变化趋势呈V字形,差异有统计学意义(P<0.05)。血浆CD4+T淋巴细胞数及CD4+/CD8+比值逐渐增高(P<0.05),但CD8+T淋巴细胞数在观察期间变化的差异无统计学意义(P>0.05)。血浆TNF-α水平先升后降,而IL-10的水平逐步升高(P<0.05),IL-10/TNF-α比值缓慢升高(P<0.05)。结论 SAP患者炎症反应强度呈先升后降趋势,这有助于治疗措施的制定。

Objective To investigate the trends of immune function changes of patients with severe acute pancreatitis （SAP） in early stage and their clinical significance .Methods Enzyme-linked immunosorbent assay（ELISA） was employed to detect the plas-ma C-reactive protein（CRP） ,IgG ,IgM ,IgA ,C3 ,C4 ,tumor necrosis factor alpha（TNF-α） and interleukin-10（IL-10） of 42 patients with SAP at different times .Flow cytometry was used to assay the plasma distribution of CD3^＋ ,CD4^＋ and CD8^＋ T lymphocyte subsets .Results Plasma CRP levels in patients with SAP showed trend of first rising and then decreasing ,while the change trends of plasma IgG and IgM were V-shaped ,with statistical difference（P〈0 .05） .The number of plasma CD4^＋ T lymphocyte and ratio of CD4^＋ /CD8^＋ were gradually increased（P〈0 .05） ,however ,the difference of CD8^＋ T lymphocyte changes during the observation period showed no significant （P〉 0 .05） .Levels of plasma TNF-α were found first increasing and then decreasing ,IL-10 levels , gradually increasing（P〈0 .05） ,and ratios of IL-10/TNF-α,slowly increasing（P〈0 .05） .Conclusion Inflammation intensity of pa-tients with SAP shows a trend of first increasing and then decreasing ,which contribute to the development of therapeutic measures .