多发创伤合并全身炎症反应综合征患者外周血中CD4^＋CD25^＋调节性T细胞的变化特点及其对细胞免疫的影响

目的观察严重多发创伤患者早期全身炎症反应综合征（SIRS）过程中CD4^＋CD25^＋调节性T细胞（CD4^＋CD25^＋Treg细胞）比例的变化，探讨其与患者继发感染之间的关系。方法符合SIRS诊断标准的23例严重多发创伤患者作为病例组，于确诊后的24h内抽取静脉血，用流式细胞仪检测CD4^＋CD25^＋Treg细胞的比例（Treg％）及CD4／CD8的比值。同时留取细胞培养，以嗜银染技术定量观察外周血淋巴细胞核仁形成区银染蛋白（Ag—NORs），以核仁银染面积与核面积的比值（IS％）表示，了解淋巴细胞的增殖情况。对人选患者于诊断成立的第1d和第5d留取痰、分泌物等标本行细菌学培养，观察患者的继发感染情况。选择同期健康查体者40例作为对照组。结果与对照组比较，病例组早期Treg％显著升高（14．21±3．43）％比（9．53±3．22），P〈0．01]，IS％及CD4／CD8显著下降（5．94±0．66）％比（6．74±0．95）％，（1．22±0．25）％比（1．72±0．36）％，P均〈0．01]。病例组中发生继发感染14例，其Treg％较无继发感染患者显著增高（18．69±4．21）％比（12．58±2．49）％，P〈0．01]，CD4／CD8显著下降（1．15±0．25）％比（1．39±0．25）％，P〈0．01]。结论检测CD4^＋CD25^＋Treg细胞的水平有助于评估严重多发创伤患者的细胞免疫状态，预测继发感染。

The change of CD4+CD25+ Treg and it's effect on cell cellular immunity in patients with systemic inflammatory response syndrome due to severe multiple trauma

Objective To investigate the percentage of CD4^＋CD25^＋Treg in peripheral blood of patients with severe multiple trauma and systemic inflammatory response syndrome （SIRS） and its effects on cellular immunity and secondary infection. Methods Peripheral blood of 23 patients with severe multiple trauma was collected in 24 h after SIRS was diagnosed, and flow cytometry was used to determine the percentage ofCD4^＋CD25^＋ Treg and CD4/CD8 ratio. Simultaneously, in order to explore the cell proliferation, silver staining was used to determine Ag-NORs of leukomonocyte in peripheral blood represented by IS%. In order to investigate the infection in patients, sputum and secretion sample were collected for bacteriological examination on 1 and 5 days after SIRS was established. Forty healthy volunteers were enrolled as control. Results Compared with the control, the percentage of CD4^＋CD25^＋Treg was significantly higher （ 14. 21±3.43）% vs （9. 53 ±3.22） ,P 〈0. 01 ] and the ratio of CD4/CD8 and IS% were significantly lower in patients with severe multiple trauma （ 5.94± 0. 66 ） % vs （6. 74 ± 0. 95 ） %, （ 1.22 ± 0. 25） % vs （ 1.72 ± 0. 36） %, respectively, both P 〈 0. 01 ]. In those patients （ n = 14） who developed secondary infection, Treg% was significantly higher （ 18.69 ± 4. 21 ）% vs （ 12. 58 ± 2.49） % ,P 〈 0. 01 ], while IS% and CD4/CD8 were significantly lower （ 5.79 ± 0. 68 ） % vs （ 6. 15 ±0.57）%,（1.15 ±0.25）% vs （1.39 ±0.25）%,both P 〈0.01] compared to the patients without secondary infection. Conlusion CD4^＋CD25^＋ Treg is valuable to estimate the cellular immunity and predict secondary infection in patients with severe muhiple trauma.