脓毒症患者血中CD4~+CD25~+调节性T细胞水平检测的临床意义

目的探讨脓毒症患者血中CD4+CD25+调节性T细胞(Treg细胞)的水平与机体细胞免疫状态的关系及其对预后的评估价值。方法纳入2007年8月至2008年8月ICU病房的脓毒症患者为病例组(n=27),健康查体者为对照组(n=40)。再将脓毒症患者根据28d预后分为死亡组(n=8)和存活组(n=19)。应用流式细胞仪技术检测Treg%、CD4/CD8。以硝酸银染色,应用图像分析系统计算核仁银染面积与核面积的比值(IS%)。结果脓毒症患者血中Treg%明显高于对照组(5.61±1.60)%比(0.78±0.23)%,P0.01],CD4/CD8和IS%明显低于对照组CD4/CD8:(1.09±0.30)比(1.71±0.36);IS%:(5.19±1.07)%比(6.76±0.92%;P均0.01]。Treg%与CD4/CD8、IS%呈显著负相关(r值分别为-0.484和-0.588,均P0.01)。死亡组血中Treg%水平明显高于存活组(7.09±1.17)%比(5.00±1.33)%,P0.01],CD4/CD8、IS%明显低于存活组CD4/CD8:(0.87±0.22)比(1.18±0.29);IS%:(3.97±0.42)%比(5.71±0.81)%;P均0.01]。结论脓毒症患者血中Treg%水平可以反映细胞免疫状态,对评估患者预后有临床价值。

Clinical Implications of Blood CD4+ CD25+ Regulatory T cells in Patients with Sepsis

Objective To investigate the relationship between blood CD4＋CD25＋ regulatory T cells （Treg cells） and cell immunity in patients with sepsis and its prognostic value.Methods 27 patients with sepsis admitted during August 2007 and August 2008 in ICU were enrolled,while 40 healthy volunteers served as control.According to the clinical outcome after 28 days’ treatment,the sepsis patients were assigned to a death group（n=8） and a survival group （n=19）.Blood Treg% and CD4/CD8 were detected by flow cytometry and total AgNOR area/nucleus area per cell （IS%） was measured by silver nitrate staining and image processing.Results The Treg% in the patients with sepsis was significant higher than that in the normal control （5.61±1.60）% vs.（0.78±0.23）%,P0.01],while the level of CD4/CD8 and IS% were significant lowerCD4/CD8：（1.09±0.30） vs.（1.71±0.36）,IS%：（5.19±1.07）% vs.（6.76±0.92）%,both P0.01].Significant correlations were found between Treg% and CD4/CD8（r=-0.484,P0.01）,and between Treg% and IS% （r=-0.588,P0.01）.Compared with the survival group,Treg% was significant higher （7.09±1.17）% vs.（5.00±1.33）%,P0.01],and CD4/CD8 and IS% were significant lowerCD4/CD8：（0.87±0.22） vs.（1.18±0.29）,IS%：（3.97±0.42）% vs.（5.71±0.81）%,both P0.01] in the death group.Conlusion Blood Treg% level can reflect the cell immune state of patients with sepsis and is of clinical value to assess the prognosis.