CD^+T细胞及Treg细胞PD-1表达水平与感染性休克预后的关系

Relationship between expression levels of CD^+T cells and Treg PD-1 in peripheral blood and prognosis of patients with septic shock

目的分析外周血CD^+T细胞及调节性T细胞(Treg)程序性死亡分子-1(PD-1)表达水平与感染性休克患者预后的关系。方法回顾性分析武汉市肺科医院2015年6月-2019年6月收治的87例患者(感染性休克组)及50名健康体检人群(对照组)的临床资料,比较两组外周血中CD^+T细胞及Treg细胞PD-1表达水平;根据感染性休克患者28 d内存活情况分为存活组和病死组,比较两组CD^+T细胞及Treg细胞PD-1表达水平,并利用受试者工作特征曲线(ROC)分析CD4^+/CD8^+及Treg细胞PD-1水平预测感染性休克患者预后的价值,Kaplan-Meier法比较CD4^+/CD8^+及Treg细胞PD-1水平与患者的28 d生存率的关系。结果感染性休克患者外周血中CD3^+、CD3^+CD4^+、CD4^+/CD8^+水平低于对照组(P<0.001),PD-1表达水平高于对照组(P<0.001);存活组患者外周血中CD3^+、CD3^+CD4^+、CD4^+/CD8^+水平高于病死组(P<0.001),PD-1表达水平低于病死组(P<0.05);ROC结果显示:CD4^+/CD8^+及PD-1表达水平预测患者28 d预后的曲线下面积分别为0.786、0.824,95%CI分别为0.689~0.884、0.725~0.923,截断值分别为0.990、19.880%;Kaplan-Meier分析结果显示:高CD4^+/CD8^+患者28 d生存率76.47%(26/34)高于低CD4^+/CD8^+患者41.51%(22/53)(P<0.001);低Treg PD-1患者28 d生存率75.00%(36/48)高于高Treg PD-1患者30.77%(12/39)(P<0.001)。结论感染性休克患者细胞免疫功能降低,而Treg上PD-1会抑制T淋巴细胞水平和免疫功能,因此CD4^+/CD8^+、Treg细胞PD-1对感染性休克患者的28 d预后有一定的预测价值。

OBJECTIVE To analyze the relationship between the expression levels of peripheral blood CD+T cells and regulatory T cells(Treg)programmed death-1(PD-1)and the prognosis of the patients with septic shock.METHODS The clinical data of 87 patients with septic shock and 50 healthy people who received physical examination in Wuhan Lung Hospital from Jun.2015 to Jun.2019 were retrospectively analyzed.The levels of peripheral blood CD+T cells and Treg PD-1 were compared between the two groups,the septic shock patients were divided into the survival group and the death group according to the 28-day prognosis,the levels of CD+T cells and Treg PD-1 were compared between the two groups,the value of CD4+/CD8+and Treg PD-1 in prediction of prognosis was analyzed by means of receiver operating characteristic(ROC)curve,and the relationship between the levels of CD4+/CD8+and Treg PD-1 and the 28-day survival rate was compared through Kaplan-Meier method.RESULTS The levels of peripheral blood CD3+,CD3+CD4+and CD4+/CD8+of the patients with septic shock were lower than those of the patients of the control group(P<0.001),the PD-1 level of the patients with septic shock was higher than that of the patients of the control group(P<0.001).The levels of peripheral blood CD3+,CD3+CD4+and CD4+/CD8+of the survival group were higher than those of the death group(P<0.001),the PD-1 level of the survival group was lower than that of the death group(P<0.001).The result of ROC showed that the AUCs of CD4+/CD8+and PD-1 were respectively 0.786 and 0.824 in prediction of 28-day prognosis;the 95%CI were 0.689~0.884 and 0.725~0.923,respectively;the Cutoff values were 0.990 and 19.880%,respectively.The result of Kaplan-Meier analysis indicated that the 28-day survival rate of the patients with high CD4+/CD8+was 76.47%(26/34),higher than 41.51%(22/53)of the patients with low CD4+/CD8+(P<0.001);the 28-day survival rate of the patients with low Treg PD-1 was 75.00%(36/48),higher than 30.77%(12/39)of the patients with high Treg PD-1(P<0.001).CONCLUSION The cellular immune function of the patients with septic shock declines,while the Treg PD-1 can inhibit levels of T lymphocytes and immune function.Therefore,CD4+/CD8+and Treg PD-1 have certain value in prediction of the 28-day prognosis of the patients with septic shock.