脓毒症相关急性肾损伤患者外周血调节性T细胞水平与肾功能恢复的关系

Changes of regulator T cells in patients with sepsis-induced acute kidney injury and the relationship with renal repair

目的:观察脓毒症相关急性肾损伤患者外周血调节性T细胞的变化,明确其与肾功能恢复的关系。方法:选择符合脓毒症相关急性肾损伤诊断标准的患者为研究对象,排除预期7d内转出或死亡的患者。在入ICU时、病程7d、14d(D1、D7、D14)留取外周血标本,应用流式细胞仪检测CD4+CD25+Foxp3+调节性T细胞(Treg)水平,随访观察时间为28d,主要观察指标为肾功能水平是否恢复。结果:根据SSC指南及KDIGO指南提出的脓毒症相关急性肾损伤(AKI)的诊断标准,南京鼓楼医院ICU在2017-01—2017-08期间共入选患者28例。发生急性肾损伤1期、2期、3期患者分别为7例、7例和14例。随访至28d时,16例患者肾功能恢复至正常,12例患者肾功能未恢复。肾功能恢复组的患者在入院时的APACHE II评分较未恢复组低,两组分别是(19.8±4.9)分和(24.9±5.0)分(P<0.05)。入院时两组的CD4+CD25+Foxp3+调节性T细胞水平差异无统计学意义(3.43±1.88vs.3.20±2.04,P>0.05),但肾功能恢复组的患者Treg细胞水平随病程逐渐上升,未恢复组的患者Treg细胞水平呈逐渐下降趋势,其中,肾功能恢复者在第14天的Treg水平远远高于肾功能未恢复者(3.89±1.56vs.1.76±0.45,P<0.05)。且肾功能恢复组的患者第14天Treg细胞水平较基线的上升率为1.32±0.70,而未恢复组的患者仅为基线水平的0.59±0.31(P<0.05)。此外,将急性肾损伤的程度与Treg细胞的水平做进一步统计分析,发现急性肾损伤1期、2期及3期的3组患者在入院时及第7天、第14天的Treg细胞水平均差异无统计学意义(P>0.05)。结论:脓毒症相关急性肾损伤患者存在Treg细胞的异常,Treg细胞的水平与急性肾损伤的程度无相关性。急性肾损伤患者外周血Treg细胞水平逐渐升高,预示着肾功能的恢复。D7、D14时Treg细胞水平的快速上升可能成为脓毒症相关急性肾损伤患者肾功能恢复的预测指标。

Objective:To investigate the level of regulator T cells in peripheral blood of patients with sepsis-induced acute kidney injury and the relationship with renal repair.Method:Patients with sepsis-induced acute kidney injury admitted in Intensive Care Unit were enrolled.CD4+CD25+Foxp3+regulator T cells were measured using flow cytometry on the day of enrolled and Day 7,Day 14.All the patients are followed up for 28 days.Result:A total of 28 patients with sepsis-induced acute kidney injury from Jan.2017 to Aug.2017 were enrolled in the study and divided into recovery group(16 cases)and non-recovery group(12 cases)according to the renal function in D28.Compared with non-recovery group,the recovery group had the lower APACHE II score(19.8±4.9 vs.24.9±5.0,P<0.05).The level of Treg cells in peripheral blood in recovery group was the same as the non-recovery group at the baseline,but significantly higher than those in the non-recovery group in D14(3.89±1.56 vs.1.76±0.45,P<0.05).Treg cells level in the recovery group gradually increased during the course of the disease,but remained low in the non-recovery group.Additionally,there were no statistical difference in between Treg cells level and severity of acute kidney injury.Conclusion:Treg cells level was lower in patients with sepsisinduced acute kidney injury,but gradually increased in recovery group.No relevance was found between the Treg cells level and the classification of acute kidney injury.The rapidly increase of Treg cells may predict the renal repair of patients with sepsis-induced acute kidney injury.