重症患者外周血T淋巴细胞亚群免疫分型的检测与临床意义

Detection and Clinical Significance of T Lymphocyte Subsets in Peripheral Blood in Severe Patients

目的探讨外周血T淋巴细胞亚群免疫分型在重症患者中的变化及临床意义。方法收集2014年1月至2015年5月我院重症加强医疗病房(ICU)的住院患者100例为观察组,并选择同期健康体检人员50例为健康对照组,采用流式细胞仪分别检测两组人员的外周血T淋巴细胞亚群数量(绝对计数)和百分数。另将观察组按序贯器官衰竭评估(SOFA)标准,分为重症组(SOFA<3分)和危重症组(SOFA≥3分)进行比较,并进行统计分析。结果观察组外周血CD_3^+淋巴细胞(简称CD_3^+)、CD_3^+CD_4^+T淋巴细胞数量(简称CD_4^+)、CD_3^+CD8^+T淋巴细胞数量(简称CD8+)、CD_4^+%、CD4^+/CD8+比值明显低于健康对照组,差异均具有统计学意义(P<0.01);而外周血CD8+%明显高于健康对照组,差异有统计学意义(P<0.01)。重症组和危重症组比较,危重症组CD_3^+、CD_4^+细胞数量、CD_4^+%、CD_4^+/CD8+比值明显低于重症组,差异均具有统计学意义(P<0.01);而CD_4^+%明显高于重症组,差异有统计学意义(P<0.01);CD8+变化不明显(P>0.05)。结论重症加强医疗病房(ICU)患者存在外周血T淋巴细胞水平异常,表明患者机体免疫功能存在障碍,且免疫功能状态与病情危重程度有关。尽早检测ICU患者外周血T淋巴细胞数量,对于ICU患者病情的早期诊断、评估及指导临床治疗具有较好的临床意义。

Objective To investigate the changes of T lymphocyte subsets in the peripheral blood and its clinical significance in the patients with severe. Methods Collected in January 2014 to May 2015 in our hospital intensive care unit（ICU）, 100 cases of hospitalized patients as the observation group and select healthy persons 50 cases as healthy control group by flow cytometry were detected two groups of researchers in peripheral blood T lymphocyte subsets（absolute count） and percentage. The observation group according to the standard of the sequential organ failure assessment（SOFA）, for the severe group（SOFA score 3 of 65 cases） and the critically ill patients group（SOFA score≥ 3 of 35 cases） were compared and statistical analysis. Results The observation group peripheral blood CD3~＋ T lymphocytes（CD3~＋）, CD3~＋CD4~＋ T lymphocyte number（CD4~＋）, CD3~＋CD8＋ T lymphocyte number（CD8＋）, CD4~＋, CD4~＋/CD8＋ ratio was significantly lower than that in healthy control group, the difference is statistically significant（P〈0.01）; peripheral blood CD8＋% was significantly higher than that in the normal control group, the difference is statistically significant（P〈0.01）. Severe group and critically ill group, critical group of disorders of CD3~＋, CD4~＋ cell number, CD4~＋, CD4~＋/CD8＋ ratio was significantly lower than that of the severe group, there were significant differences, with statistical significance（P〈0.05）; and CD4~＋ were significantly higher than those in the severe group, the difference is statistically significant（P〈0.01）; CD8＋ change is not obvious（P〉0.05）. Conclusions The abnormal levels of peripheral blood T lymphocytes in the patients with severe enhanced medical wards（ICU） indicated that the immune function of the patients was impaired, and the immune function state was related to the severity of the disease. Early detection of T lymphocyte number in patients with ICU, the early diagnosis, assessment and clinical treatment of ICU patients with disease has good clinical significance.