程序性死亡受体1与T细胞及其亚群比率的变化对脓毒症急性肺损伤患者的影响

The Effect of Changes in the Ratio of Programmed Death Receptor 1 to T Cells and Its Subpopulation on Patients with Sepsis and Acute Lung Injury

目的探讨脓毒症急性肺损伤患者程序性死亡受体1(PD-1)与T细胞及其亚群间的关系。方法选取2021年1月至2022年1月医院收治的30例脓毒症急性肺损伤患者为研究组,选取同期30例脓毒症无急性肺损伤患者为对照组、30名健康体检者为空白组。收集3组外周静脉血样本、序贯性脏器衰竭评价(SOFA)评分和急性生理和慢性健康状况(APACHEⅡ)评分,比较3组炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)和C反应蛋白(CRP)]水平,CD4^(+)、CD8^(+)和CD4^(+)CD25^(+)Treg细胞数量及PD-1阳性表达情况,并分析CD4^(+)、CD8^(+)和CD4^(+)CD25^(+)Treg细胞数量及PD-1阳性表达情况对脓毒症急性肺损伤患者不同预后的影响。结果对照组、研究组的IL-6、CRP、TNF-α水平高于空白组,差异有统计学意义(P<0.05);对照组、研究组CD4^(+)、CD8^(+)及CD4^(+)CD25^(+)Treg细胞计数比较,差异有统计学意义(P<0.05);对照组和研究组在CD4^(+)、CD8^(+)、CD4^(+)CD25^(+)Treg细胞表面的PD-1阳性表达情况与APACHEⅡ、SOFA评分比较,差异均有统计学意义(P<0.05);CD4^(+)、CD8^(+)、CD4^(+)CD25^(+)Treg细胞表面PD-1水平与APACHEⅡ、SOFA评分呈正相关(P<0.05)。死亡患者CD4^(+)PD-1、CD8^(+)PD-1、CD4^(+)CD25^(+)PD-1水平均高于生存患者,差异均有统计学意义(P<0.05);CD4^(+)PD-1预测患者不良预后的灵敏度、特异度为72.19%、84.61%;CD8^(+)PD-1的灵敏度、特异度为84.61%、72.26%;CD4^(+)CD25^(+)PD-1的灵敏度、特异度为60.31%、81.43%。结论脓毒症急性肺损伤患者CD4^(+)、CD8^(+)、CD4^(+)CD25^(+)细胞计数显著改变,CD4^(+)PD-1、CD8^(+)PD-1、CD4^(+)CD25^(+)PD-1表达增加且对脓毒症急性肺损伤患者预后具有一定的预测价值。

Objective The relationship between programmed death receptor 1(PD-1)and T cells and its subpopulation in patients with sepsis and acute lung injury was explored.Methods With the selection of 30 patients with sepsis and acute lung injury admitted to the hospital from January 2021 to January 2022 as the research group,selection of 30 patients with sepsis during the same period as the control group,and collection of 30 healthy individuals during the same period as the blank group,the peripheral venous blood samples,Sequential Organ Failure Assessment(SOFA)scores,and Acute Physiological and Chronic Health Status(APACHEⅡ)scores were collected from three groups.The levels of inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)],the number of CD4^(+),CD8^(+)and CD4^(+)CD25^(+)Treg cells and the positive expression of PD-1 in the 3 groups were compared.In addition,the number of CD4^(+),CD8^(+)and CD4^(+)CD25^(+)Treg cells and the positive expression of PD-1 on the prognosis of patients with acute lung injury in sepsis were analyzed.Results The expression levels of IL-6,CRP and TNF-αin the control group and the research group were higher than those in blank group,and the differences were statistically significant(P<0.05);The differences of CD4^(+),CD8^(+)and CD4^(+)CD25^(+)Treg cell counts between control group and research group were statistically significant(P<0.05);In the control group and the research group,the positive expression of PD-1 on the surface of CD4^(+),CD8^(+)and CD4^(+)CD25^(+)Treg cells was significantly different from that of APACHEⅡand SOFA scores(P<0.05);The level of PD-1 on the surface of CD4^(+),CD8^(+)and CD4^(+)CD25^(+)Treg cells was positively correlated with APACHEⅡand SOFA scores(P<0.05).The levels of CD4^(+)PD-1,CD8^(+)PD-1 and CD4^(+)CD25^(+)PD-1 in death patients were higher than those in survival patients,and the differences were statistically significant(P<0.05);The sensitivity and specificity of CD4^(+)PD-1 in predicting poor prognosis for patients were 72.19%and 84.61%,respectively;The sensitivity and specificity of CD4^(+)CD25^(+)PD-1 were 60.31%and 81.43%,respectively.Conclusion The CD4^(+),CD8^(+),CD4^(+)CD25^(+)cell counts were significantly changed in patients with sepsis and acute lung injury,and the expression levels of CD4^(+)PD-1,CD8^(+)PD-1,CD4^(+)CD25^(+)PD-1 were increased,which had certain predictive value for the prognosis of patients with sepsis and acute lung injury.