婴幼儿脓毒症外周血T淋巴细胞亚群表达及临床意义

Expressions of T lymphocyte subsets in peripheral blood of infants and clinical significance

目的探究婴幼儿脓毒症外周血T淋巴细胞亚群表达及临床意义。方法选取2019年1月-2021年1月金华市中心医院脓毒症患儿84例为病例组,另选取同期入院体检的健康婴幼儿84名为对照组,病例组患儿根据不同病情程度分为脓毒症患儿39例、严重脓毒症患儿28例、脓毒性休克患儿17例,检测外周血T淋巴细胞亚群、炎症标志物[C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)水平],分析T淋巴细胞亚群与炎症标志物、病情程度及预后的关系。结果病例组患儿外周血CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平低于对照组,CRP、PCT、IL-6、CD_(8)^(+)高于对照组(P<0.05);病例组不同病情程度患儿外周血CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)、CRP、PCT、IL-6水平差异有统计学意义(P<0.05),外周血CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平随脓毒症病情程度加重呈不断降低趋势,CD_(8)^(+)、CRP、PCT、IL-6水平随脓毒症病情程度加重呈逐渐升高趋势(P<0.05);外周血CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)与脓毒症病情程度、CRP、PCT、IL-6呈负相关,CD_(8)^(+)与脓毒症病情程度、CRP、PCT、IL-6呈正相关(P<0.05);随访30 d,外周血CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)高水平患儿生存率高于低水平患儿,CD_(8)^(+)高水平患儿生存率低于低水平患儿(P<0.05)。结论外周血T淋巴细胞亚群CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)与婴幼儿脓毒症炎症反应、病情程度显著相关,并对预后产生重要影响。

OBJECTIVE To explore the expressions of T lymphocyte subsets in peripheral blood of infants and analyze the clinical significance.METHODS A total of 84 infants with sepsis who were treated in Jinhua Central Hospital from Jan 2019 to Jan 2021 were assigned as the case group,meanwhile,84 healthy infants who received physical examination were chosen as the control group.The infants of the case group were divided into the sepsis group with 39 cases,the severe sepsis group with 28 cases and the septic shock group with 17 cases according to the severity of illness condition.The levels of peripheral blood T lymphocyte subsets and inflammatory markers[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)]were detected.The relationship between the T lymphocyte subsets and the inflammatory markers,severity of disease and prognosis was observed.RESULTS The levels of peripheral blood CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)of the case group were lower than those of the control group,while the levels of CRP,PCT,IL-6 and CD_(8)^(+)of the case group were higher than those of the control group(P<0.05).There were significant differences in the levels of peripheral blood CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+),CRP,PCT and IL-6 among the children with different severity of disease in the case group(P<0.05);the levels of peripheral blood CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)showed downward trends with exacerbation of sepsis,while the levels of CD_(8)^(+),CRP,PCT and IL-6 showed upward trends with the exacerbation of sepsis(P<0.05).The peripheral blood CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)were negatively correlated with the severity of sepsis,CRP,PCT and IL-6;the CD_(8)^(+)was positively correlated with the severity of sepsis,CRP,PCT and IL-6(P<0.05).A 30-day follow-up showed that the survival rate of the infants with high expression levels of peripheral blood CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)was higher than that of the infants with low expression levels,while the survival rate of the infants with high expression level of CD_(8)^(+)was lower than that of the infants with low expression level(P<0.05).CONCLUSION The peripheral blood T lymphocyte subsets CD_(3)^(+),CD_(4)^(+),CD_(8)^(+)and CD_(4)^(+)/CD_(8)^(+)are remarkably associated with the inflammatory reactions and severity of sepsis of the infants,which also have significant effect on prognosis.