T细胞免疫功能变化对严重烧伤病人的影响及调节机制

目的研究T淋巴细胞免疫功能的变化对严重烧伤病人的影响及机制。方法选择35例严重烧伤病人，分为脓毒症组（20例）和非脓毒症组（15例）。分别于两组患者伤后1d、5d、10d、15d、20d、25d采集外周静脉血分离T淋巴细胞。方法采用放射免疫法检测白细胞介素2、4、6、8（IL-2、IL-4、IL-6、IL-8）、TNF-α的水平，通过流式细胞仪检测CD4＋／CD8＋T淋巴细胞的百分率及其凋亡率。结果与非脓毒症组比较，脓毒症组患者伤后1d、5d、10d、15d、20d、25dT淋巴细胞的TNF和IL-2、IL-4、IL-6、IL-8的分泌水平均显著升高（P〈0．05或P〈0．01），两指标呈显著正相关（r=0．78，P〈0．01）。伤后1d、5d、10d、15d、20d、25d，脓毒症组患者CD4＋／CD8＋T淋巴细胞的百分率明显低于非脓毒症组，而其凋亡率呈相反趋势（P〈0．05或P〈0．01），两指标呈显著负相关（r=0．73，P〈0．05）。结论严重烧伤后，T淋巴细胞免疫功能持续处于抑制状态；T淋巴细胞凋亡参与了脓毒症细胞免疫素乱的病理生理过程。

Adjustment mechanism of changes of T lymphocyte immunity function in severe burn patients

Objective To observe the immunological function changes and adjustment mechanism of T lymphocyte in severe burn patients. Methods 35 severe burn patients were divided into sepsis group （S, n= 20） and non-sepsis group （NS, n=15）. The peripheral venous blood samples of the patients were collected on 1, 5, 10, 15, 20 and 25 after the burn days （PBD）. RIA methods were used to determine TNF-α. The apoptosis rate was determined by flow cytome- try. Results Compared with that in NS group, the proliferration ability of T lymphocyte and the level of TNF, IL-2, IL- 4, IL-6 and IL-8 were significantly decreased in patients in S group on 1, 5, 10, 15, 20 and 25 PBD（P〈0.05 or P〈0.01）. The inhibition of T lymphocyte proliferation was positively correlated to the low level of IL-6 production in burn patients（r=0.78,P〈0.01）. The percentage of CD4＋ / CD8＋ T lymphoeytes in S group were obviously lower than that in NS group on 1, 5, 10, 15, 20 and 25 PBD, whereas on opposite tendency in the apoptosis rate of CD4＋/CD8＋ T lymphocytes were found at the same time （P〈0. 05 or P〈0.01）. The percentage of CD4＋ / CD8＋ T lymphocytes were negatively correlated to apoptosis rate of T lymphocytes（r=-0. 73,P〈0.05）. Conclusion The immunological function of T lymphocytes in severe burn patients depressed persistently. Apoptosis of T lymphocyte may participate in the pathological process of cell immunological disorder induced by sepsis.