脓毒症患者T淋巴细胞亚群变化及与炎症状态的关系研究

Correlation analysis between T lymphocyte subsets and inflammation in patients with sepsis

目的研究脓毒症患者的T 淋巴细胞亚群变化及与炎症状态的关系。方法选取2015 年3 月—2018 年10 月浙江大学医学院附属杭州市第一人民医院脓毒症患者126 例作为观察组,另选取同期健康体检者60 例作为对照组。检测并比较两组的T 淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)和炎症因子[血沉(ESR)、降钙素原(PCT)、C 反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子α(TNF-α)、高迁移率族蛋白B1(HMGB-1)],采用Pearson 检验T 淋巴细胞亚群与炎症指标的相关性。结果观察组入院时CD8^+及血清PCT、CRP、IL-6、TNF-α、IL-10、HMGB-1 水平高于对照组(P <0.05),而CD4+、CD4+/CD8+低于对照组(P <0.05)。PCT、CRP、IL-6、IL-10、TNF-α在入院6 h 达到峰值;严重脓毒症组和脓毒症休克组各个时间点的CD4^+、CD4^+/CD8^+低于脓毒症组,CD8^+、PCT、CRP、IL-6、IL-10、TNF-α高于脓毒症组,ESR 在入院5 d 时高于脓毒症组,而HMGB-1 在入院7 d 时高于脓毒症组,差异有统计学意义(P <0.05),且严重脓毒症组与脓毒症休克组比较,差异有统计学意义(P <0.05)。脓毒症患者的CD4^+、CD8^+、CD4^+/CD8^+与血清PCT、CRP、IL-6、IL-10、TNF-α和HMGB-1 均呈线性相关(P <0.05)。结论脓毒症患者存在明显的T 淋巴细胞紊乱和促炎/抗炎失衡,且病情越重其免疫-炎症紊乱越明显,动态监测T 淋巴细胞亚群及炎症因子水平可为病情评估及治疗决策提供参考。

Objective To study the correlation between T lymphocyte subsets and inflammation status in patients with sepsis. Methods A total of 126 patients with sepsis who were admitted to our hospital from March 2015 to October 2018 were enrolled as the observation group, and 60 healthy subjects were selected as the control group. The T lymphocyte subsets (CD4^+, CD8^+, CD4^+/CD8^+) and d inflammatory factors including erythrocyte sedimentation rate (ESR), procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor -α(TNF-α), and high mobility group box-1 (HMGB1)] were detected. Results At the time of admission, the CD8^+ and serum levels of PCT, CRP, IL-6, TNF-α, IL-10 and HMGB1 in the observation group were higher than those in the control group, while the amount of CD4^+ and CD4^+/CD8^+ cells were lower than those in the control group (P < 0.05). The levels of PCT, CRP, IL-6, IL-10 and TNF-α reached peak levels at 6 hours after admission. Levels of CD4^+ and CD4^+/CD8^+ were lower while the levels of CD8^+, PCT, CRP, IL-6, IL-10, TNF-α levels were higher (P < 0.05) in severe sepsis group and septic shock group than those in the sepsis group at various points in time. Levels of ESR was higher in severe sepsis group than that in the sepsis group at 5th days after admission, and the HMGB1 was higher in severe sepsis group than that in sepsis group on the 7th day of admission (P < 0.05). CD4^+, CD8^+, CD4^+/CD8^+ in patients with sepsis were linearly correlated with serum PCT, CRP, IL-6, IL-10, TNF-α and HMGB1 (P < 0.05). Conclusion Sepsis patients experience with obvious T lymphocyte disorder and proinflammatory/anti-inflammatory imbalance, and dynamic monitoring of T lymphocyte subsets/ inflammatory factor levels may provide basis of illness and treatment decision-making.