Th17／Treg失衡在重症肺炎中的作用及其意义

Imbalance of Th17/Treg in Severe Pneumonia

目的探讨Th17／Treg在评估重症肺炎病情和预后中作用。方法收集2011年6月至2013年6月我院确诊并住院治疗的重症肺炎患者400例，正常对照者200例。流式细胞术分析重症肺炎组和对照组外周血Th17细胞和Treg细胞的百分率，酶联免疫吸附实验（enzyme linked immunosorbent assay, ELISA）检测各组外周血细胞因子IL-17和IL-10的表达水平。结果重症肺炎患者外周血Th17和Treg的百分率及细胞因子IL．17较对照组均明显升高，而IL-10表达水平明显低于对照组，差异均具有统计学意义（P〈0．05）。进一步分析显示重症肺炎中继发多器官功能衰竭综合症（multiple organ dysfunction syndrome,MODS）组患者Th17和Treg的百分率，外周血IL-17表达水平均明显高于非MODS组．外周血IL-10表达水平明显低于非MODS组，差异均具有统计学意义（P〈0．05）。死亡患者Th17和Treg的百分率，外周血IL-17表达水平均明显高于存活组，外周血IL-10表达水平明显低于存活组，差异均具有统计学意义（P〈0．05）。结论Th17／Treg失衡参与了重症肺炎的发生发展，检测外周血Th17和Treg的百分率及其相应细胞因子水平对评估重症肺炎的病情和预后有重要的临床意义。

Objective To explore the role of Th17/Treg in the prediction of disease severity and prognosis in patients with severe pneumonia. Methods A total of 400 patients with severe pneumonia who were treated between June 2011 and June 2013 in our hospital were enrolled in the study, and 200 healthy individuals served as control group. The percentage of Th17 and Treg in the peripheral blood of each group was analyzed by flow cytometry, and the levels of IL-17 and IL-10 were measured by enzyme linked immunosorbent assay （ELISA） . Results The percentages of Th17 and Treg were both significantly increased in patients with severe pneumonia compared with those in control group （P 〈 0. 05 ） . The level of peripheral IL-17 was significantly increased and the level of IL-10 significantly decreased in patients with severe pneumonia compared with those in control group （P 〈0. 05） . Furthermore, the percentages of Th17 and Treg, and the level of IL- 17 were profoundly increased and the level of IL-10 was significantly decreased in patients with secondary multiple organ dysfunction syndrome （MODS） compared with patients without MODS （P 〈 0. 05） . The similar pattern was also observed in patients who died of secondary MODS compared with those who survived secondary MODS （P 〈 0. 05） . Conclusion The imbalance of Th17/Treg participants into the onset and progress of severe pneumonia, and the percentages of ThlT/Treg as well as the level of associated cytokines are associated with the severity and prognosis of severe pneumonia.