脓毒症患儿外周血Th17细胞水平的变化 及其临床意义

摘要:目的　探讨外周血辅助性T 细胞17（Th17）细胞水平在儿童脓毒症发病中的作用及临床价值。方法　选取脓毒症患儿36例；健康儿童20例为正常对照组。分离外周淋巴细胞后，分别采用流式细胞仪检测Th17细胞比例；实时荧光定量PCR（qRT-PCR）技术检测Th17细胞特异性转录因子即维甲酸受体相关孤儿受体γt（RORγt）mRNA 表达水平；酶联免疫吸附法（ELISA）检测血清IL-6，IL-17及IL-23的含量。结果　与健康对照组比较，脓毒症患儿组外周血Th17细胞比例增高（t＝3.68，P＜0.05）；脓毒症患儿组RORγt mRNA 表达水平也显著高于健康对照组（t＝8.32，P＜0.05）；同时脓毒症患儿组细胞因子含量（IL-6，IL-17，IL-23）明显高于健康对照组（P＜0.05）。此外，脓毒症死亡组患儿外周血Th17细胞水平（2.2±0.5）%显著高于存活组（0.8±0.3）%（t＝4.67，P＜0.05），外周血Th17细胞比例与患儿死亡率呈正相关（r＝0.24，P＜0.001）。结论　Th17细胞参与了脓毒症的炎症反应，检测Th17细胞水平有助于儿童脓毒症的早期诊断、治疗及预后的判断。

Change and clinical value of Th17 cells levels in the peripheral blood of children with sepsis

Abstract: Objectives To investigate the role and clinical value of Th17 cell in children with sepsis. Methods 36 cases of sepsis were enrolled as study group; 20 cases of healthy children were selected as control group. After separating periheral blood lymphocyte, the percentage of Th17 cell was detected by FCM; the expression of RORγt mRNA was measured by qT-PCR; the levels of IL-6, IL-17 and IL-23 in serum were measured by ELISA. Results Compared with control group, the proportion of Th17 cells in sepsis group was higher (t=3.68, P<0.05); the levels of RORγt mRNA expression in sepsis were also significantly higher than in healthy control group (t=8.32, P<0.05); the levels of cytokine such IL-6, IL-17 and IL-23 were significantly higher in sepsis group than in healthy control group (P<0.05). Moreover, the Th17 cells levels was significantly higher in death group (2.2±0.5, %) than these survival group (0.8±0.3, %) (t=4.67, P<0.05); The Th17 cells levels and death rates were positively associated (r=0.24, P<0.001). Conclusion Th17 cells are involved in the inflammation associated with sepsis. Detecting the level of Th17 cells is helpful for the judgement of early diagnosis, treatment and prognosis of sepsis in children.