严重多发伤患者伤后调节性T细胞的变化及其与损伤严重度和脓毒症的关系

目的 观察严重多发伤患者伤后外周血调节性T细胞(Treg细胞)的变化及其与脓毒症和损伤严重度的关系. 方法 60例严重多发伤患者按ISS评分排序后分为严重组(30例),危重组(30例);按是否伴发脓毒症分为脓毒症组(22例)和非脓毒症组(38例).于伤后1,3,5,8 d用流式细胞仪检测各组患者外周血Treg细胞的比率. 结果 严重多发伤患者伤后5 dTreg细胞比率开始升高,与伤后3 d相比差异有统计学意义(P<0.01);伤后8 d仍持续升高(P<0.05).伤后8 d,危重组外周血Treg细胞比率显著高于严重组(P<0.01),脓毒症组外周血Treg细胞比率显著高于非脓毒症组(P<0.05).Spearman相关分析显示Treg细胞比率与ISS评分呈正相关(rs=0.654,P<0.01). 结论 Treg细胞在严重创伤后的免疫抑制中扮演着重要的角色,Treg细胞比率的变化有助于评估患者的预后及判断并发脓毒症的危险度.

Variation of T regulatory cells and its relation with injury severity and sepsis in patients with se-vere multiple injury

Objective To observe change of T regulatory cells (Tregs) and its relation with in-jury severity and sepsis following severe muhiple injury. Methods A total of 60 patients were em-ployed in the study and divided into severe group (30 patients) and critical group (30 patients) based on ISS scores and into sepsis group (22 patients) and non-sepsis group (38 patients) based on complication of sepsis. The proportion of Tregs in peripheral blood in different groups was detected by flow cytometry at days 1,3,5 and 8 after injury. Results The proportion of Tregs was significantly increased at day 5 postinjury, with statistical difference compared with that at day 3 postinjury (P < 0.01). The proportion of Tregs remained increasing at day 8 pestinjury (P < 0.05). At day 8 postinjury, the proportion of Tregs in critical group was significantly higher than that in severe group (P < 0.01). At the same time, the proportion of Tregs in sepsis group was significantly higher than that in non-sepsis group (P < 0.05). Spearman correlation analysis showed a positive correlation of Tregs proportion with ISS score (rs =0.654, P < 0.01). Conclusions Tregs play an important role in suppression of T cell-mediated im-munity after severe injury. The variation of Tregs can help evaluate prognosis and predict the risk of com-plicating sepsis in patients with severe multiple injury.