不同液体限制性复苏对创伤失血性休克病人外周血Th17和Treg细胞比例的影响

目的探讨不同液体限制性复苏对创伤失血性休克病人外周血辅助性T细胞17（Th17）和调节性T细胞（Treg）比例及相关细胞因子水平的影响，为临床选择复苏液提供参考。方法选择创伤失血性休克病人56例作为研究对象（创伤组），随机分为醋酸钠林格氏液（AR）组和乳酸钠林格氏液（LR）组，各28例，另选择健康医师志愿者18名设为对照组。采集受试者外周血，采用流式细胞术检测各组外周血Th17和Treg比例，采用酶联免疫吸附试验检测各组外周血白细胞介素（IL）-17、IL-6、IL-23和肿瘤坏死因子α（TNF-α）水平。结果与对照组比较，创伤组（LR组+AR组）外周血Th17、Treg比例及IL-17、IL-6、IL-23和TNF-α水平均明显升高（P < 0.01）。复苏前，LR组和AR组病人外周血Th17、Treg比例及相关细胞因子水平差异均无统计学意义（P>0.05）。复苏后30 min，LR组Th17比例和IL-6、TNF-α水平升高幅度均大于AR组（P < 0.05~P < 0.01）；2组Treg比例、IL-17、和IL-23水平变化差异无统计学意义（P>0.05）。复苏后1 h，LR组和AR组各指标变化差异均无统计学意义（P>0.05）。结论与乳酸钠林格液相比，使用醋酸钠林格液早期复苏能更进一步抑制创伤失血性休克病人外周血Th17、IL-6和TNF-α释放，进而减轻病人机体炎症反应。

Effects of different fluid-restricted resuscitation on the expression of Th17, Treg cells and related cytokines in peripheral blood of patients with traumatic hemorrhagic shock and its clinical significance

ObjectiveTo investigate the effect and clinical significance of different fluid resuscitation in patients with hemorrhagic shock on the percentage of helper T cell 17(Th17) and regulatory T cell(Treg) in peripheral blood and related cytokines, and to provide reference for clinical screening of relatively ideal resuscitation fluid.MethodsFifty-six patients with traumatic hemorrhagic shock were enrolled as the trauma group.All patients were randomly divided into sodium acetate Ringer's solution (AR) group.And the sodium lactate Ringer's solution (LR) group, 28 cases in each, 18 cases of our hospital health physician volunteers were selected as the control group.Peripheral blood was collected and the ratio of Th17 and Treg in peripheral blood was detected by flow cytometry.The levels of IL-17, IL-6 and IL-23 TNF-α level in peripheral blood of each group were detected by enzyme-linked immunosorbent assay (ELISA).ResultsCompared with the control group, the peripheral blood Th17 and Treg ratios and the levels of IL-17, IL-6, IL-23 and TNF-α in the trauma group (LR group+AR group) were significantly increased (P < 0.01).Before resuscitation, there was no significant difference in the peripheral blood Th17, Treg ratio and cytokine levels between the two groups of patients in the trauma group (P>0.05).Thirty minutes after resuscitation, the increase in Th17 ratio and IL-6 and TNF-α levels in the LR group were greater than those in the AR group (P < 0.05 to P < 0.01);there was no significant difference in the level of Treg ratio, IL-17, and IL-23 in the two groups(P>0.05).One hour after resuscitation, there was no statistically significant difference in the changes of the two groups (P>0.05).ConclusionsCompared with sodium lactate Ringer's solution, the early resuscitation with sodium acetate Ringer's solution further inhibits the release of Th17 cells and IL-6 and TNF-α in peripheral blood of patients with traumatic hemorrhagic shock, thereby reducing the patient's body inflammation.