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高龄非甲状腺性病态综合征患者外周血单核细胞的功能变化
引用本文:吴军,钱云峰,许卫国,陈蕊,肖飞,孙杰,熊日成,俞宙,郭振辉.高龄非甲状腺性病态综合征患者外周血单核细胞的功能变化[J].广东医学,2016(1):69-72.
作者姓名:吴军  钱云峰  许卫国  陈蕊  肖飞  孙杰  熊日成  俞宙  郭振辉
作者单位:1. 广州军区广州总医院老年病中心 广州510010;2. 广东省老年感染与器官功能支持重点实验室 广州510010
基金项目:广州市科技计划项目(编号2014J4100033)
摘    要:目的:探讨高龄非甲状腺性病态综合征( NTIS)患者外周血单核细胞( PBMCs)功能的变化。方法根据临床症状、实验室检查和甲状腺激素变化情况,排除原发性或继发性甲状腺疾病后,将住院高龄患者分为甲状腺功能正常组( A组,40例)、NTIS组( B组,33例)、NTIS并全身炎症反应综合征( SIRS)组( C组,36例)、NTIS并脓毒症组(D组,54例)。用流式细胞仪检测患者PBMCs表面人白细胞抗原-DR(HLA-DR)的表达;用MTT方法检测PBMCs刺激同种异体T淋巴细胞的增殖实验,用ELISA方法检测经内毒素( LPS)刺激前后PBMCs分泌肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)等细胞因子的水平。结果与A组比较,B组患者PBMCs表面HLA-DR的表达、刺激同种异体T淋巴细胞的增殖能力、经LPS刺激后分泌TNF-α、IL-6、IL-10细胞因子的水平差异均无统计学意义( P>0.05);与B组比较,C、D两组患者PBMCs表面HLA-DR的表达、刺激T细胞增殖能力以及分泌细胞因子的水平均显著性减低( P<0.05)。 D组上述免疫功能指标较C组有下降趋势,但C、D两组之间差异无统计学意义(P>0.05)。结论甲状腺激素水平减低本身不引起PBMCs功能的变化;SIRS或脓毒症所致NTIS的患者PBMCs功能减低。

关 键 词:高龄  非甲状腺性病态综合征  全身炎症反应综合征  脓毒症  外周血单核细胞

Changes of peripheral blood monocytes function in elderly patients with nonthyroid illness syndrome
Abstract:Objective To investigate the changes of peripheral blood monocytes ( PBMCs) function in elderly pa-tients with nonthyroid illness syndrome(NTIS).Methods Hospitalized elderly patients who were ruled out of primary thyroid diseases and secondary thyroid diseases were divided into 4 groups, Group A, 40 elderly patients with euthyroid-ism;Group B, 33 elderly patients with NTIS;Group C, 36 elderly patients with NTIS and systemic inflammatory response syndrome( SIRS);and Group D, 54 elderly patients with NTIS and sepsis based on clinical characteristics, laboratory data and the level of level of serum thyroid hormone.Human leukocyte antigen-DR( HLA-DR) of PBMCs were detected by flow cytometry.PBMCs were isolated for allogeneic T lymphocyte proliferation and further detection by methyl thiazolyl tet-razolium ( MTT) colorimetry.After stimulation of PBMCs with LPS, the levels of PBMC-secreted cytokines, including TNF-α, IL-6, and IL-10, were measured with ELISA.Results Expression of HLA-DR in PBMCs, proliferation of allogeneic T cells stimulated by PBMCs, and the levels of PBMC-secreted TNF-α, IL-6, and IL-10 were not signifi-cantly different between Groups A and B (P>0.05).Compared with Group B, HLA-DR, the proliferation of allogeneic T cells , and the levels of PBMC-secreted cytokines were significantly reduced in Groups C and D (P<0.05).No sta-tistically significant differences were detected between Group C and Group D.Conclusion Reduced level of thyroid hor-mone does not cause alteration of PBMC functions.NTIS patients caused by SIRS or sepsis undergoes PBMC dysfunction.
Keywords:elderly patients  nonthyroid illness syndrome  systemic inflammatory response syndrome  sepsis  peripheral blood monocytes
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