感染源性急性呼吸窘迫综合征患者血Th1和Th2细胞及相关细胞因子检测的临床意义

Clinical significance of blood Th1,Th2 cells and their cytokines in evaluating the condition and prognosis of patients with infection-induced acute respiratory distress syndrome

目的探讨感染源性急性呼吸窘迫综合征(ARDS)患者外周血Th1和Th2细胞及其相关细胞因子干扰素(IFN)-γ、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-2、IL-4、IL-5及IL-13水平与ARDS病情严重程度及其预后的关系。方法选择2019年6月至2020年8月我院住院诊断的感染源性ARDS患者58例,符合2012年柏林定义。选择同期我院健康体检者30名为对照组。详细收集患者临床资料,参照柏林定义分类标准分为轻中度组(PaO 2/FiO 2≥150mmHg,1mmHg=0.133kpa)32例和中重度组(PaO 2/FiO 2<150mmHg)26例。其中肺部感染诱发的ARDS患者47例,肺外感染性脓毒症源性ARDS患者11例,两组病因构成差异无统计学意义。ARDS患者确诊后24h,抽取清晨外周静脉血,采用流式细胞技术检测血清Th1、Th2细胞及其相关细胞因子IFN-γ、TNF-α、IL-2、IL-4、IL-5、IL-13水平。结果ARDS患者入院后24h:轻中度组、中重度组Th1细胞与Th2细胞显著高于健康对照组(P<0.05),中重度组Th1细胞显著高于轻中度组(P<0.05)。两组ARDS患者血清IFN-γ、IL-4及IL-13表达水平均较健康对照组显著升高(P<0.05)。中重度组ARDS患者:血清IFN-γ、IL-13表达水平显著高于轻中度组(P<0.05);抗炎因子IL-4表达水平显著低于轻中度组(P<0.05)。ARDS患者血清IFN-γ、IL-13表达水平与总住院时间呈正相关(r分别为:0.543,P<0.01;0.436,P<0.05),与住院病死率呈正相关(r分别为:0.476,0.502,均P<0.01)。IL-4表达水平与总住院时间和住院病死率呈负相关(r分别为:-0.542,-0.485,均P<0.05)。结论感染源性ARDS患者外周血Th1和Th2细胞及其相关细胞因子IFN-γ、IL-4、IL-13明显升高。血IFN-γ、IL-4及IL-13表达水平与病情严重程度和预后相关。

Objective To investigate the relationship of the levels of Th1 and Th2 cells and their cytokines IFN-γ,TNF-2,IL-2,IL-4,IL-5 and IL-13 in peripheral blood with the severity and prognosis of patients with infection-induced acute respiratory distress syndrome(ARDS).Methods 58 patients with ARDS diagnosed from June 2019 to August 2020 were selected,and they were divided into the mild to moderate group(32 cases)and the moderate to severe group(26 cases)according to clinical setting on the first day after diagnosis of ARDS and Berlin Definition of ARDS in 2012.Their clinical data were collected.Whole blood and serum samples were taken on the day of admission for all confirmed cases,the number of Th1 and Th2 was detected by flow cytometry,and the expression levels of IFN-γ,IL-2,IL-4,IL-5 and IL-13 were determined by ELISA.Results On the first day after diagnosis of ARDS,the number of Th1 and Th2 in the mild to moderate group and the moderate to severe group was higher than that in the control group(P<0.05),and the number of Th1 in the moderate to severe group was higher than that in the mild to moderate group(P<0.05).The serum levels of IFN-γ,IL-4 and IL-13 were significantly increased in the mild to moderate group and the moderate to severe group(P<0.05).The serum expression levels of IFN-γand IL-13 was higher in the moderate to severe group than that in the mild to moderate group(P<0.05).The expression level of IL-4 was significantly lower in the moderate to severe group than that in the mild to moderate group(P<0.05).The expression levels of IFN-γand IL-13 in patients with ARDS were positively correlated with the duration of hospital stay and positively correlated with mortality in hospital.The expression level of IL-4 was negatively correlated with the duration of hospital stay and the mortality in hospital.Conclusion The number of Th1 and Th2 cells and their associated inflammatory factors IFN-γ,IL-4 and IL-13 are elevated in patients with ARDS.The serum levels of IFN-γ,IL-13 and IL-4 are correlated with the severity and prognosis of patients with infection-induced ARDS.