Th17/Treg免疫平衡在老年人重症急性胰腺炎继发性感染中的变化及意义

Changes and the significance of Th17/Treg immune imbalance in secondary systemic infection in patients with severe acute pancreatitis

目的 探讨Th17/Treg免疫平衡在老年重症急性胰腺炎患者继发性感染中的变化及意义. 方法 选择重症急性胰腺炎合并继发性感染患者（感染组）21例、重症急性胰腺炎患者（非感染组）25例,健康体检者（对照组）20例,比较各组外周血Th17/Treg细胞及相关细胞因子表达水平. 结果 感染组病死率、重症监护病房（ICU）住院天数与非感染组比较[23.8％比4.0％、（11.3±3.4）d比（7.5±2.8）d],差异均有统计学意义（x2=3.949,P=0.047;t=2.890,P=0.045）.感染组Th17细胞百分比、Treg细胞百分比、Th17/Treg比值、白介素-6（IL-6）、白介素-17（IL-17）、白介素-23（IL-23）、转化生长因子-β1（TGF-β1）和孤独受体（ROR-γt）mRNA分别为（26.4±1.2）％、（6.7±1.6）％、（4.3±1.0）％、（7.1±0.8）ng/L、（22.9±2.4）ng/L、（15.7±2.1）ng/L、（23.6±2.2）ng/L和0.052±0.014,非感染组分别为（12.8±0.9）％、（4.2±1.3）％、（3.2±1.1）％、（5.3±0.7） ng/L、（15.6±2.8）ng/L、（10.2±1.5）ng/L、（16.3±1.7）ng/L和0.035±0.010,与对照组（3.1±0.8）％、（1.3±0.4）％、（2.4±0.9）％、（0.2±0.1） ng/L、（10.3±1.5）ng/L、（8.3±1.4）ng/L、（11.6±1.1）ng/L和0.004±0.001比较均明显升高（F=15.761、55.745、9.437、102.788、21.038、16.239、36.957、23.924,P=0.555、0.000、0.014、0.000、0.002、0.004、0.000、0.000）.感染组IL 10、Foxp3-TmRNA分别为（6.4±1.1） ng/L、（0.005±0.001）,非感染组分别为（10.5±2.1）ng/L、（0.020±0.007）,与对照组（15.4±2.0）ng/L、（0.032±0.009）比较明显降低（F=18.995、20.608,P=0.003、0.002）. 结论 合并继发性感染可加重重症急性胰腺炎患者Th17/Treg免疫失衡,延长ICU住院时间.

Objective To investigate changes and the significance of Th17/Treg immune imbalance in secondary systemic infection in patients with severeacute pancreatitis.Methods We selected 21 patients with severe acute pancreatitis and secondary systemic infection （infection group）,25 patients with severe alone （non-infection group）,20 healthy cases undergoing annual health checkup （control group） in this study.The expression levels of Th17/Treg cells and related cytokines were compared between groups.Results There were significant differences in mortality rate and duration of ICU stay between infection group and non-infection group [23.8% vs.4.0%,（11.3±3.4） d vs.（7.5±2.8） d,x2=3.949,t=2.890,P=0.047 and0.045].The percentages of Th17 cell andTreg cell,Th17/Treg ratio,mRNA expressions of IL-6,IL-17,IL-23,TGF-β and orphan receptor γt were higher in infection and non infection groups than in control group [（26.4 ± 1.2） %,（12.8 ± 0.9）% vs.（3.1±0.8） %;（6.7±1.6）%,（4.2±1.3）% vs.（1.3±0.4）%;（4.3±1.0）%,（3.2±1.1）% vs.（2.4±0.9）%;（7.1±0.8）ng/L,（5.3±0.7）ng/L vs.（0.2±0.1）ng/L;（22.9±2.4）ng/L,（15.6±2.8）ng/L vs.（10.3± 1.5）ng/L;（15.7±2.1）ng/L,（10.2± 1.5）ng/L vs.（8.3± 1.4）ng/L;（23.6±2.2）ng/L,（16.3±1.7）ng/L vs.（11.6±1.1）ng/L;（0.052±0.014）,（0.035± 0.010） vs.（0.004±0.001）;F=15.761,55.745,9.437,102.788,21.038,16.239,36.957,23.924,respectively,P=0.555,0.000,0.014,0.000,0.002,0.004,0.000,0.000].The mRNA expressions of IL-10 and Foxp3-T were lower in infection and non-infection groups than in control group [（6.4±1.1）ng/L,（10.5 ± 2.1） ng/L vs.（15.4±2.0）ng/L;（0.005±0.001）,（0.020±0.007） vs.（0.032±0.009）,F=18.995 and 20.608,P=0.003 and 0.002].Conclusions The secondary infection can aggravate the Th17 / Treg immune imbalance in patients with severe acute pancreatitis,and extend the ICU hospitalization days.