儿童脓毒症T细胞亚群选择性缺失与血清降钙素原的关系及意义

Correlation and significance of selective defects of T cell subgroup and serum procalcitonin concentration in children with sepsis

目的探讨脓毒症患儿血清降钙素原(PCT)水平与其T细胞亚群选择性缺失的关系,并阐明二者在早期判断儿童脓毒症严重程度上的意义。方法依据2005年国际儿科脓毒症联席会议标准及小儿危重病例评分法(PCIS)将2013年6月至2014年3月该科收治的70例脓毒症患儿分为非危重组37例(PCIS>80分)和危重组33例(PCIS≤80分)。另同期选择30例健康儿童作为健康对照组。采用流式细胞仪检测各组儿童T细胞亚群,应用免疫发光分析法检测儿童血清PCT水平,比较PCT水平与T细胞亚群及其选择性缺失的关系。分析血清PCT水平与T细胞亚群选择性缺失在早期评估儿童脓毒症严重程度上的意义。结果与健康对照组比较,非危重组出现CD3+T、CD4+T表达率及CD4+T/CD8+T比值下降;与非危重组比较,危重组CD3+T、CD4+T、CD8+T、CD56+T表达率及CD4+T/CD8+T比值均下降,差异均有统计学意义(P<0.05或0.01)。脓毒症患儿血清PCT水平与CD3+T、CD4+T、CD19+T表达率及CD4+T/CD8+T校正值呈负相关(P<0.05或0.01);PCT水平和CD19+T表达率与患儿PCIS评分呈负相关(P<0.01),而CD3+T、CD4+T、CD8+T、CD56+T表达率及CD4+T/CD8+T校正值与PCIS评分呈正相关(P<0.05或0.01)。结论脓毒症患儿T细胞亚群呈选择性缺失,CD4+/CD8+失衡程度与血清PCT水平呈负相关,二者与儿童脓毒症的严重程度密切相关,可作为早期判断脓毒症严重程度的指标。

Objective To approach the correlation of selective defects of T cell subgroups and serum procalcitonin con-centration in children with sepsis,and set forth its significance in judgment of the severity degree of sepsis in children at early phase. Methods In line with the standard of International Pediatrics Sepsis Consensus Conference published in 2005 and pedia-tric critical cases scoring method（PCIS）,a total of 70 children with sepsis admitted by department of internal pediatrics of Maternal and Child Health Hospital of Hu Bei Province from June 2013 to March 2014 were divided into the non-critical group（n=37,PCIS80 points） and the critical group（n=33,PCIS≤80 points）. Additionally,another 30 healthy children at the same period were the healthy control group. It adopted flow cytometry（FCM） to detect their T-lymphocyte subgroups of each group and immunoluminescence analysis to detect serum PCT concentration of children,then contrasting their correlation. It was analyzed the significance of PCT concentration and selective defects of T cell subgroups in the judgment of the severity of sepsis in children in the early stage.Results Compared with the healthy control group,the percentages of CD3＋T,CD4＋T and ratio of CD4＋T/CD8＋T in the non-critical group were decreased. Compared to the non-critical group,all the value of CD3 ＋T,CD4 ＋T,CD8 ＋T,CD56 ＋T and ratios of CD4＋T/CD8＋T,whose difference had statistical significance（P〈0.05 or 0.01）. There was a linear negative correlation between the expression rate of CD3＋T,CD4＋T,CD19＋T,the adjusted value of ratio of CD4＋T/CD8＋T and serum PCT concentration（P〈0.05 or0.01）. PCT concentration and expression rate of CD19＋T demenstrated a negative correlation with PCIS of children patients,however,the expression rate of CD3 ＋T,CD4 ＋T,CD8 ＋T,CD56 ＋T and the adjusted value of ratio of CD4 ＋T/CD8 ＋T were positively correlated with PCIS（P〈0.05 or 0.01）. Conclusion T cell subgroups in children with sepsis showed selective defects,the imbalance of CD4＋T/CD8＋T was negatively correlated with serum PCT concentration,both of which had a close relation with sepsis in children,being indicators judging the severity degree of sepsis in children in the early stage.