脓毒症患者免疫功能障碍与炎症的相关性分析

Correlation analysis between immune dysfunction and inflammation in patients with sepsis

目的研究脓毒症患者免疫功能障碍与炎症的相关性。方法选择2013年2月至2017年5月本院重症监护病房(ICU)收治的脓毒症患者80例作为试验组,选择同期常规体检的健康人80例作为对照组。用流式细胞仪检测测定免疫指标和以酶联免疫吸附法测定炎症因子,相关性分析用Pearson检验,回归分析用Logistic检验。结果试验组的血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)含量分别为(85.73±15.34),(58.04±9.11)pg·m L^(-1),都明显高于对照组的(12.33±8.24),(17.49±8.76)pg·m L^(-1),组间比较差异均有统计学意义(均P<0.05)。试验组的CD4^+、CD8^+值分别为(48.71±11.16)%和(22.11±11.09)%,对照组分别为(35.75±11.31)%和(28.83±11.36)%,组间比较差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,在试验组80例患者中,IL-6、TNF-α与CD4^+呈现明显正相关性(均P<0.05);而其与CD8^+呈现明显负相关性(P<0.05)。Logistic回归分析显示,IL-6、TNF-α、CD4^+、CD8^+都是影响急性生理与慢性健康(APAHCEⅡ)评分的主要独立危险因素(均P<0.05)。结论脓毒症患者体内存在炎性反应状态与免疫功能障碍,两者可相互影响,影响患者的APAHCEⅡ评分。

Objective To investigate and analysis the correlation between immune dysfunction and inflammation in patients with sepsis.Methods From February 2013 to May 2017,80 cases of sepsis patients in our hospital intensive care unit were selected as the treatment group,and the other 80 healthy people were enrolled as control group. The inflammatory factors,such as interleukin-6（ IL-6） and tumor necrosis factor α（ TNF-α） were deternied by enzyme linked immunosorbent assay. The immune function index（ CD4^＋ and CD8^＋） were detected by flow cytometry. The correlation were analyzed. Results The contents of serum IL-6 and TNF-α in the treatment group were（ 85. 73 ± 15. 34）,（ 58. 04 ± 9. 11） pg·m L^-1,respectively,which were significantly higher than（ 12. 33 ± 8. 24）,（ 17. 49 ± 8. 76） pg · m L^-1 in the control group with significantly（ all P〈0. 05）. The CD4^＋ and CD8^＋ values in the treatment group were（ 48. 71 ± 11. 16） % and（ 22. 11 ± 11. 09） %,and the control group were（ 35. 75 ± 11. 31） % and（ 28. 83 ± 11. 36） % respectively. The difference comparison between the two groups were statistically significant（ all P〈0. 05）. Among the 80 patients in the treatmentgroup,Pearson correlation analysis showed that IL-6 and TNF-α were positively correlated with CD4^＋（ all P〈0. 05）,but negatively correlated with CD8^＋（ P〈0. 05）. Logistic regression analysis showed that IL-6,TNF-α,CD4^＋ and CD8^＋ were the major independent risk factors for affecting Acute Physiology and Chronic Health Evaluation（ APAHCE）Ⅱ score（ all P〈0. 05）. Conclusion There are inflammatory reaction and immune dysfunction in sepsis patients that they can interact with each other and affect the APAHCE II score.