脓毒症患者CD4+CD25+调节性T细胞的变化及其与预后的关系

目的 评价脓毒症患者外周血中CD4+CD25+调节性T细胞的变化趋势及其与预后的相关性.方法 采用流式细胞仪检测36例脓毒症患者自诊断成立第1、3、5天的CD4+CD25+细胞/CD4+细胞比值,并与15例健康体检者(对照组)比较.按照预后分为生存组和死亡组,分析两组CD4+CD25+调节性T细胞随时间的变化.结果 脓毒症患者19例生存,17例死亡.生存组和死亡组第1天CD4+CD25+细胞/CD4+细胞比值均低于对照组分别为(12.42±3.26)%、(12.96±3.00)%比(16.97±3.66)%.P＜0.05].生存组和死亡组第3天CD4+CD25+s细胞/CD4+细胞比值分别为(24.47±4.62)%和(26.61±3.85)%.均高于第1天,差异有统计学意义(P＜0.05).生存组第5天CD4+CD25+细胞/CD4+细胞比值为(18.28±4.28)%,较第3天显著下降,差异有统计学意义(P＜0.05);死亡组第5天CD4+CD25+细胞/CD4+细胞比值为(36.19±5.33)%,较第3天显著升高,差异有统计学意义(P＜0.05).第1、3天生存组和死亡组比较差异均无统计学意义(P＞0.05);第5天生存组CD4+CD25+细胞/CD4+细胞比值显著低于死亡组(P＜0.05).结论 脓毒症患者血中CD4+CD25+调节性T细胞呈现先下降后上升的变化,而持续上升提示出现免疫功能麻痹,伴随病死率的升高.CD4+CD25+调节性T细胞可作为临床评价脓毒症患者炎性反应中免疫功能状态和预后的方便可靠的指标.

Changes of CD4+CD25+ regulatory T cells in sepsis patients and its relationship with prognosis

Objective To evaluate the changes of peripheral blood CD4+CD25+ regulatory T cells and its prognostic value in sepsis patients.MethodThe percentage of CD4+CD25+/CD4+ T cells were measured by flow eytometry present in peripheral blood in 36 sepsis patients on day 1,3 and 5 and 15 healthy people (control group).The changes of CD4+CD25+ regulatory T cells were analyzed in survivors group and non-survivors group respectively.Results There were 19 survivors and 17 non-survivors in sepsis patients.The percentage of CD4+CD25+/CD4+ T cells in survivors group and non-survivors group on day 1 was significantly lower than that in eontrol group (12.42± 3.26)%,(12.96± 3.00)% vs (16.97 ± 3.66)%,P＜0.05].The percentage of CD4+CD25+/CD4+ T cells in survivors group and non-survivors group on day 3 were both signifieanfly higher than that on day 1 (24.47±4.62)%vs (12.42±3.26)%,(26.61±3.85)%vs (12.96±3.00)%,P＜0.05].The percentage of CD4+CD25+/CD4+ T cells in survivors group on day 5(18.28±4.28)%]was significantly lower than that on day 3 (P＜0.05),and the percentage of CD4+CD25+/CD4+ T cells in nonsurvivors group on day 5 were significantly higher than that on day 3(P＜0.05).There was no significant difference in the percentage of CD4+CD25+/CD4+ T ceils between survivors group and non-survivors group on day 1,3 respeefively(P ＞ 0.05),but the percentage of CD4+CD25+/CD4+ T cells in survivors group was significantly lower than that in non-survivors group on day 5 (P＜0.05).Conclusions The CD4+CD25+ regulatory T cells in sepsis patients decreases following by increase after onset.The persistent increase suggests the emergence of immunoparalysis,which is followed by high monaliy,The CD4+CD25+ regulatory T cells are valuable in evaluation of immune state and prediction the prognosis in sepsis patients.