脓毒症患者免疫失衡与疾病严重程度的关系

摘要

目的 通过研究脓毒症患者外周静脉血CD14+单核细胞人类白细胞抗原(HLA)-DR及辅助T淋巴细胞 (Th)亚群的动态变化,评价患者的免疫状态及其与疾病的严重程度和预后的关系.方法 在患者被诊断为脓毒症后的第1、4、28天/出重症监护病房(ICU)/死亡前抽取静脉血,应用流式细胞仪连续检测CD14+单核细胞HLA-DR表达和Th各亚群比例,同时记录当天的APACHE Ⅱ评分.结果.脓毒症组(A组)患者19例,重度脓毒症组(B组)27例.B组较A组CD14+单核细胞HLA-DR表达水平、Th1细胞百分率及Th1/Th2比值明显降低,Th2细胞百分率则明显增高(P均<0.01).CD14+单核细胞HLA-DR表达水平、Th1细胞百分率及Th1/Th2比值与APACHEⅡ评分存在显著负相关.B组患者入院第4天起CD14+单核细胞HLA-DR表达水平维持于较低水平(均低于30%);Th1细胞百分率及Th1/Th2比值随时间迁延呈下降趋势,Th2细胞百分率呈上升趋势,与A组比较差异有统计学意义(P均<0.01).结论.重度脓毒症患者存在明显的CD14+单核细胞HLA-DR表达水平下调和Th1/Th2漂移,免疫抑制更显著,表现为单核、T淋巴细胞免疫功能受抑制,Th2细胞和抗炎反应优势可能是导致这一免疫功能紊乱的重要原因.%Objective To monilor ihe changes of CD14+ monocyle human leukocyle anligen DR level and helper T lymphocyle subsel in seplic palienls, so as Lo discuss ihe relationship of immune slalus wilh severily and prognosis of sepsis. Methods Afler ihe diagnosis of sepsis was made, human leukocyle anligen ( HLA) - DR expression on CD14+ monocyle and subsels of CD4+ helper T lymphocytes (Th1/Th2) were measured by flow cylomelry ( FCM) on ihe lsl, 4lh, 7lh, 14 ih and 28 ih days or ihe lasl day in ICU. Al ihe same lime, ihe APACHE II scores were calculated. Results Tolally 46 palienls were enrolled in ihis sludy, wilh 19 sepsis and 27 severe sepsis. The CD14+ monocyle HLA - DR expressions, percentage of Th, and Th,/Th2 ralio in the severe seplic group were significantly lower lhan those in ihe septic group (P<0. 01). The percentage of Th2 in the severe seplic group was significantly higher lhan thai in the seplic group ( P < 0. 01 ). APACHE II score was negatively correlated with ihe level of CD14 + monocyle HLA - DR expression, ihe percentage of Th, as well as ralio of Th,/Th2. From the 4lh day after admission, ihe expression of CD14+ monocyle HLA - DR, percentage of Th, and ratio of Th,/Th2 decreased wilh lime, whereas ihe percentage of Th2 cells look an increase tendency in ihe severe septic group, and ihere was significant difference compared wilh the seplic group (P<0. 01). Conclusion The lower CD14+ monocyle HLA - DR expression and ihe shift from Th1 lo Th2 suggest more critical immune suppression slates for severe seplic patienls. Thedominances of Th2 and and - inflammalory response may be ihe main reasons for ihe incompetence of immune syslem.