脓毒症患者淋巴细胞亚群及其比值的变化参与免疫调节的意义

Significance of changes of lymphocyte subsets and their ratios in patients with sepsis in immune regulation

目的探讨脓毒症患者淋巴细胞亚群及其比值的变化参与免疫调节的意义。方法这是一项单中心、横断面研究,研究对象为南京医科大学附属明基医院2020年1月—2022年3月收治的55例脓毒症患者和同期招募的50名年龄匹配的健康对照组。根据脓毒症和脓毒症休克的定义,将55例脓毒症患者进一步分为脓毒症组(39例)和脓毒症休克组(16例)。通过流式细胞仪定量外周血中CD4^(+)T淋巴细胞、CD8^(+)T淋巴细胞、B淋巴细胞和NK细胞。结果脓毒症组的CD8^(+)T淋巴细胞、NK细胞百分比均低于对照组(P<0.05);脓毒症休克组的NK细胞百分比显著低于对照组(P<0.05)。脓毒症组的B淋巴细胞百分比、CD4^(+)T/CD8^(+)T、B/NK显著高于对照组和脓毒症休克组(P<0.05)。脓毒症组的CD8^(+)T淋巴细胞百分比、T/B、CD4^(+)T/B、CD8^(+)T/B显著低于对照组和脓毒症休克组(P<0.05)。B淋巴细胞百分比、CD4^(+)T/CD8^(+)T、T/NK、CD4^(+)T/NK、CD8^(+)T/NK和B/NK在脓毒症诊断中的AUC分别为0.609、0.560、0.671、0.645、0.602和0.680,其临界值分别为18.6、1.57、4.89、3.05、2.18和1.16。T淋巴细胞百分比、CD8^(+)T淋巴细胞百分比、T/B、CD4^(+)T/B、CD8^(+)T/B和CD8^(+)T/NK在脓毒症休克诊断中的AUC分别为0.649、0.739、0.680、0.600、0.725和0.628,其截断值分别为73.7、26.8、6.25、3.57、2.26和4.28。结论脓毒症患者的免疫表达模式不是淋巴细胞数量的简单减少,因为淋巴细胞亚群功能比率的变化可能在脓毒症的进展中更为关键。

Objective To explore the significance of the changes of lymphocyte subsets and their ratios in patients with sepsis in immune regulation.Methods This was a single-center,cross-sectional study.The subjects of the study were 55 sepsis patients admitted to our hospital from January 2020 to March 2022 and 50 age-matched healthy controls recruited.According to the definition of sepsis and septic shock,patients with sepsis were further divided into sepsis group(39 cases)and septic shock group(16 cases).CD4^(+)T lymphocytes,CD8^(+)T lymphocytes,B lymphocytes and NK cells in peripheral blood were quantified by flow cytometry.Results The percentages of CD8^(+)T lymphocytes and NK cells in the sepsis group were significantly lower than those in control group(P<0.05).The percentage of NK cells in septic shock group was significantly lower than that in control group(P<0.05).The percentage of B lymphocytes,CD4^(+)T/CD8^(+)T,and B/NK in the sepsis group were significantly higher than those in control group and septic shock group(P<0.05).The percentage of CD8^(+)T lymphocytes,T/B,CD4^(+)T/B,and CD8^(+)T/B in sepsis group were significantly lower than those in the control group and septic shock group(P<0.05).The AUC of B lymphocyte percentage,CD4^(+)T/CD8^(+)T,T/NK,CD4^(+)T/NK,CD8^(+)T/NK,and B/NK in the diagnosis of sepsis were 0.609,0.560,0.671,0.645,0.602,and 0.680,respectively,with the critical values of 18.6,1.57,4.89,3.05,2.18,and 1.16,respectively.The AUC of T lymphocyte percentage,CD8^(+)T lymphocyte percentage,T/B,CD4^(+)T/B,CD8^(+)T/B,and CD8^(+)T/NK in the diagnosis of septic shock were 0.649,0.739,0.680,0.600,0.725,and 0.628,respectively,with the cutoff values of 73.7,26.8,6.25,3.57,2.26,and 4.28,respectively.Conclusion The pattern of immune expression in patients with sepsis is not a simple decrease in the number of lymphocytes,as changes in the functional ratio of lymphocyte subsets may be more critical in the progression of sepsis.