新生儿脓毒症外周血CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg 表达水平及意义

Expression of CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg in peripheral blood of neonates with sepsis and its significance

目的 探讨新生儿脓毒症外周血CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)调节性B细胞(Breg)表达水平及临床意义。方法 将2018年7月-2020年10月于湖北医药学院附属襄阳市第一人民医院新生儿科出生的110例脓毒症新生儿及同期收住的96例胎龄、日龄相匹配但无感染征象的新生儿分别纳入脓毒症组及对照组;脓毒症组患儿以21 d为观察终点,分为死亡组22例,存活组88例。检测外周血CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg细胞比例、白细胞介素-10(IL-10)水平。结果 对照组不同时间点CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg细胞水平及外周血IL-10比较,无统计学差异;与第0天相比,脓毒症组CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg细胞水平及外周血IL-10水平在第3、7天时升高并高于对照组(P<0.05)。存活组第0、3、7天时CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg细胞水平及第3、7天时外周血IL-10水平均高于死亡组(P<0.05);第3天时CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg细胞水平评估的曲线下面积(AUC)最大,截点值为30.19%,第7天时IL-10水平评估预后的AUC最大,截点值为192.73 pg/ml。结论 CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg细胞水平、IL-10水平与脓毒症新生儿病情程度、预后密切相关,发病后早期CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg细胞、IL-10水平的变化可作为评估预后的参考指标。

OBJECTIVE To explore the expression of CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)regulatory B cells(Breg) in peripheral blood of neonates with sepsis and analyze its clinical significance. METHODS A total of 110 neonates with sepsis who were born in neonatology department of Xiangyang First People’s Hospital Affiliated to Hubei Medical College from Jul 2018 to Oct 2020 were assigned as the sepsis group, meanwhile, 96 neonates with matched gestational age and day age who did not have signs of infection were chosen as the control group. The percentage of CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg cells and interleukin-10(IL-10) level of the two groups were detected. The children of the sepsis group were divided into the death group with 22 cases and the survival group with 88 cases according to the 21-day survival status. RESULTS There were no significant differences in the CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg cell level and the peripheral blood IL-10 level among the neonates of the control group at different time points. As compared with the levels on Day 0, the CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg cell level and peripheral blood IL-10 level of the sepsis group were significantly higher than those of the control group on Day 3 and Day 7(P<0.05). The CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg cell level on Day 0, 3 and 7 and the peripheral blood IL-10 level on Day 3 and 7 were significantly higher in the survival group than in the death group(P<0.05). The area under curve(AUC) of the CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg cell level on Day 3 was largest, the cutoff value was 30.19%, the AUC of the IL-10 level on Day 7 was the largest, and the cutoff value was 192.73 pg/ml. CONCLUSION The CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg cell level and IL-10 level are closely associated with the severity of illness and prognosis of the neonates with sepsis. The changes of CD_(19)^(+)CD_(24)^(hi)CD_(38)^(hi)Breg cell and IL-10 in early stage after onset can be served as reference indexes for assessment of prognosis.