T淋巴细胞凋亡在心脏骤停患者免疫抑制和预后评估中的作用

Role of T lymphocytes apoptosis in immunosuppression and prognosis of cardiac arrest

目的通过观察心脏骤停(cardiac arrest,CA)患者早期外周血T淋巴细胞亚群和T淋巴细胞凋亡的变化规律,探讨其在免疫评估和预测预后中的临床意义。方法选取2014年1月至2018年2月在北京朝阳医院急诊科救治的CA患者43例(复苏组),以同期健康体检者15例为对照组。以入院28d生存率为终点,分为存活组和死亡组,应用流式细胞仪检测外周血T淋巴细胞亚群计数和T淋巴细胞凋亡,分析发病第1、2、3天的急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分,T淋巴细胞亚群计数和凋亡的变化,以及与APACHEⅡ评分的相关性。结果与同期健康体检者比较,复苏组在发病第1、2、3天外周血T淋巴细胞凋亡率明显增加(%:17.17±0.56,18.52±0.60,20.24±0.90vs.9.87±0.76,P<0.05),CD4^+T淋巴细胞亚群计数水平明显降低(%:36.67±0.77,32.44±0.80,25.32±0.79vs.45.10±1.05,P<0.05);与生存组比较,死亡组在发病第1、2、3天较生存组的CD4^+T淋巴细胞亚群计数凋亡明显降低(%:29.16±7.82vs.41.76±1.83,31.60±6.23vs.38.71±2.10,33.14±5.16vs.37.24±3.28,P<0.05);第2、3天CD4+T淋巴细胞亚群计数与APACHEⅡ评分存在明显负相关(r=0.362,P=0.016;r=0.427,P=0.013)。结论T淋巴细胞计数是评估CA患者免疫功能和预后的良好指标,在复苏后的早期,机体出现T淋巴细胞凋亡增加和T淋巴细胞计数明显减少,提示复苏后机体免疫功能受损和CA患者的病死率升高。

Objective To observe the change rule of T lymphocyte subsets and cell apoptosis in patients with cardiac arrest (CA),so as to explore the clinical significance of the related immune assessment and prognosis prediction.Methods A total of 43 patients with CA who have been treated in the emergency department of Beijing Chaoyang Hospital from January 2014 to February 2018 were selected. By taking the survival rate on the 28 day of hospitalization as the end of observation,the patients were divided into the survival group and the death group.Changes of APACHE Ⅱ scores,T lymphocyte subsets levels and T lymphocyte apoptosis on the 1st,2nd and 3rd day after admission were analyzed.Results On the 1 st,2nd and 3rd day after onset compared with normal control group,the apoptosis rate of T lymphocytes in peripheral blood increased significantly in CA patients (%:17.17 ±0.56,18.52 ±0.60, 20.24 ±0.90 vs.9.87 ±0.76,P <0.05 ),and the T lymphocyte subsets decreased significantly (36.67 ±0.77,32.44 ±0.80,25.32 ±0.79 vs.45.10 ±1.05,P <0.05).Compared with the survival group,the apoptosis of T Iymphocytes in the death group increased significantly (%:29.16 ± 7.82 vs.41.76 ±1.83,31.60 ±6.23 vs.38.71 ±2.10,33.14±5.16 vs.37.24±3.28,P <0.05), and the T lymphocyte subsets decreased significantly.In addition,the T lymphocyte subsets levels were significantly negatively correlated with APACHE Ⅱ scores,and the correlation coefficients are respectively -0.362 (P=0.016)and-0.427 (P =0.013).Conclusion Count of the T lymphocyte subsets is a good indicator to evaluate the immune function and outcomes of patients with CA.In the early stages of the resuscitation,the body appears increased T lymphocyte apoptosis and decreased T lymphocyte count significantly.A constantly decrease of T lymphocyte count indicates impaired immune function and increased mortality of patients.