脓毒症患者Th1/Th2细胞失衡与疾病严重程度、肺损伤的关系

Relationship between Th1/Th2 cell imbalance and disease severity,lung injury in patients with sepsis

目的探讨脓毒症患者Th1/Th2细胞失衡与疾病严重程度、肺损伤的关系。方法将2017年10月至2019年10月于本院ICU接受治疗的62例脓毒症患者根据治疗28 d后临床结局的不同分为死亡组(20例)和生存组(42例),分别于入ICU治疗前1 d,入ICU治疗后1、7、14 d通过流式细胞术检测两组外周静脉血中Th1细胞(IFN-γ^+CD3^+CD4^+T淋巴细胞)及Th2细胞(IL-4^+CD3^+CD4^+T淋巴细胞)的含量,并计算Th1/Th2值,分析比较两组Th1、Th2细胞含量及Th1/Th2值。根据脓毒症患者是否合并肺损伤分别肺损伤组(24例)和非肺损伤组(38例),分析比较两组Th1、Th2细胞含量及Th1/Th2值。结果治疗后1、7、14 d,生存组Th1细胞含量及Th1/Th2值均明显高于死亡组,差异具有统计学意义(P<0.05),而Th2细胞含量与死亡组比较差异无统计学意义(P>0.05)。肺损伤组Th1细胞含量及Th1/Th2值均明显高于非肺损伤组,差异具有统计学意义(P<0.05),而Th2细胞含量与非肺损伤组比较差异无统计学意义(P>0.05)。结论Th1/Th2值的降低预示着疾病严重程度的加大,预后不良,同时脓毒症合并肺损伤患者促炎Th1细胞增高,Th1/Th2平衡向Th1方向漂移。

Objective To explore the relationship between Th1/Th2 cell imbalance and disease severity,lung injury in patients with sepsis.Methods Sixty-two patients with sepsis who were treated in ICU of the hospital from October 2017 to October 2019 were divided into the death group(20 cases)and the survival group(42 cases)according to the clinical outcomes after 28 d of treatment.At 1 d before entering ICU,and at 1,7 and 14 d after entering ICU,contents of Th1 cells(IFN-γ^+CD3^+CD4^+T lymphocytes)and Th2 cells(IL-4^+CD3^+CD4^+T lymphocytes)in peripheral venous blood in both groups were detected by flow cytometry.The ratio of Th1/Th2 was calculated.The contents of Th1 and Th2 cells,and Th1/Th2 were analyzed and compared between the two groups.According to presence or absence of lung injury,they were further divided into the lung injury group(24 cases)and lung non-injury group(38 cases).The contents of Th1 and Th2 cells,and Th1/Th2 were analyzed and compared between the two groups.Results At 1,7 and 14 d after treatment,contents of Th1 cells and Th1/Th2 in the survival group were significantly higher than those in the death group(P<0.05),while differences in contents of Th2 cells were not statistically significant between the two groups(P>0.05).The contents of Th1 cells and Th1/Th2 in the lung injury group were significantly higher than those in the lung non-injury group(P<0.05),while the differences in contents of Th2 cells were not statistically significant between the two groups(P>0.05).Conclusion The decrease of Th1/Th2 ratio indicates the aggravation of disease severity and poor prognosis.The pro-inflammatory Th1 cells are increased in patients with sepsis and lung injury,and the Th1/Th2 balance drifts to Th1.