重症急性胰腺炎感染期CD4+ T淋巴细胞内ATP含量的变化

目的:探讨CD4+T淋巴细胞内三磷酸腺苷(ATP)含量在重症急性胰腺炎(SAP)感染期的变化。方法:将南开医院收治的42例SAP患者(SAP组)及36名健康志愿者(对照组)纳入研究。SAP组入院后于1,4,7,14,21 d用ImmuKnowTM免疫细胞功能测定试剂盒检测CD4+T淋巴细胞内ATP值,对照组以相同的时间间隔做相同的检测。之后根据SAP组是否进入感染期分为感染组(18例)和非感染组(24例)。分析和比较3组ATP含量的变化,并用受试者工作特征(ROC)曲线分析ATP含量变化对判断SAP继发感染的价值。结果:对照组CD4+T淋巴细胞ATP含量保持稳定。两个SAP组的ATP含量变化趋势基本一致,入院后第1,4天两组的ATP含量明显高于对照组(P<0.05),第7天两组ATP含量明显降低,均于第14天降至最低水平,其中感染组下降程度明显大于非感染组(P<0.05),随后两组ATP含量开始回升,第21天非感染组ATP含量已基本接近对照组,但感染组仍低于对照组(P<0.05)。ROC曲线分析表明,当CD4+T细胞内ATP值降低(<151.55 ng/mL)时,SAP继发感染的机率明显增加;ATP含量的降低对判断SAP继发感染的敏感度为0.810,特异度为0.605。结论:CD4+T淋巴细胞内ATP含量可较准确地反映SAP患者的整体细胞免疫功能状况和继发感染的风险。

Alteration of ATP level in CD4+ T lymphocytes during infection stage of severe acute pancreatitis

Objective: To investigate the relations of the ATP level in the CD4+ T lymphocytes during the infection stage of severe acute pancreatitis(SAP). Methods: Forty-two SAP patients(SAP group) admitted to Nankai Hospital and 36 healthy volunteers(control group) were enrolled in this study.The ATP value in the CD4+ T lymphocytes of the SAP group were measured by ImmuKnowTM assay on day 1,4,7,14 and 21 after admission and the control subjects underwent the same assessment at matched intervals.Afterwards,according to whether the patients entered the infection stage or not,the SAP group was further divided into the infection group(18 cases) and non-infection group(24 cases).The ATP level variations among the 3 groups were analyzed and compared,and the receiver operating characteristic curve was used to assess the value of using the ATP level alteration to estimate the secondary infection of SAP. Results: The ATP in the CD4+ T lymphocytes of the control group maintained a consistent level.The ATP levels of the two SAP groups altered in a roughly parallel pattern,both which increased significantly compared to the control group on day 1 and 4 after their hospitalization(P<0.05),but declined significantly on day 7 and reached the lowest values on day 14,and then picked up gradually.The decreasing extent of the ATP level of the infection group was greater than that of the non-infection group(P<0.05),and the ATP level of the non-infection group was approximately close to that of the control group but the infection group was still significantly lower than the control group(P<0.05).ROC curve analysis showed that the SAP patients would experience an increased risk of secondary infection when their ATP level in the CD4+ T lymphocytes deceased(<151.55 ng/mL),and the sensitivity and specificity of using the ATP level alteration to estimate the secondary infection of SAP were 0.810 and 0.605,respectively. Conclusion: The ATP level in CD4+ cells can relatively reflect the overall cellular immunological competence and the risk to secondary infection for SAP patients.