本文選題：膿毒癥 + T淋巴細(xì)胞��； 參考：《重慶醫(yī)科大學(xué)學(xué)報(bào)》2016年07期

【摘要】：目的:研究膿毒癥患者外周血T淋巴細(xì)胞亞群和T淋巴細(xì)胞凋亡的變化,探討其在免疫抑制和預(yù)后中的作用。方法:收集2014年10月至2015年12月重慶醫(yī)科大學(xué)附屬第一醫(yī)院ICU收治的膿毒癥患者55例,隨訪患者28 d生存率,根據(jù)預(yù)后不同,分為膿毒癥患者存活組和膿毒癥患者死亡組;同時收集健康志愿者30例為對照組。應(yīng)用流式細(xì)胞儀檢測患者外周血T細(xì)胞亞群計(jì)數(shù),分析其與APACHEⅡ評分及預(yù)測死亡危險(xiǎn)率(R)的相關(guān)性;用免疫磁珠分選外周血CD3+T淋巴細(xì)胞,通過流式細(xì)胞技術(shù)和Tunel法檢測細(xì)胞凋亡。用膿毒癥患者和健康志愿者血清體外刺激Jurkat細(xì)胞24 h,采用流式細(xì)胞技術(shù)和Tunel染色法檢測細(xì)胞凋亡,Western blot法檢測激活型天冬氨酸特異性半胱氨酸蛋白酶(cleaved-caspase 3),B細(xì)胞淋巴瘤-2(B-cell lymphoma-2,Bcl-2)和髓樣細(xì)胞白血病-1(myeloid cell leukemia 1,Mcl-1)蛋白表達(dá)水平。結(jié)果:膿毒癥患者存活組、死亡組T淋巴細(xì)胞各亞群絕對值計(jì)數(shù)均明顯低于對照組,分別為:CD3+374.0(274.5~514.0)、154.0(87.5~256.2)、1534.5(1255.0~1756.7),CD3+CD4+198.0(148.5~299.0)、68.0(37.7~108.5)、766.5(629.3~923.5),CD3+CD8+142.0(89.0~184.0)、76.0(48.7~134.5)、600.5(400.2~717.0)(全部P0.05);膿毒癥患者死亡組CD3+、CD3+CD4+細(xì)胞計(jì)數(shù)減少均較膿毒癥患者存活組更顯著,差異具有統(tǒng)計(jì)學(xué)意義(P=0.011,P=0.005)。膿毒癥患者死亡組外周血T淋巴細(xì)胞中CD3+CD4+細(xì)胞占(42.40±5.71)%,較對照組(53.46±9.28)%明顯減少(P=0.003);CD3+CD8+細(xì)胞占(54.40±4.76)%,較對照組(39.33±7.26)%增加(P=0.003);CD4+/CD8+比值為(0.79±0.17),較對照組(1.44±0.51)明顯下降(P=0.023)。CD3+、CD3+CD4+、CD3+CD8+、CD4+/CD8+比值與患者APACHEⅡ評分和R均呈負(fù)相關(guān)關(guān)系(全部P0.05)。膿毒癥患者存活組、死亡組CD3+T淋巴細(xì)胞凋亡率分別為(15.59±0.54)%、(39.57±4.49)%,較對照組(9.53±1.91)%明顯增加(P=0.040,P=0.000),膿毒癥患者死亡組較膿毒癥患者存活組增加更明顯(P=0.000)。膿毒癥患者存活組、死亡組血清誘導(dǎo)Jurkat細(xì)胞凋亡率分別為(16.60±3.55)%、(32.93±5.89)%,較對照組(8.56±0.89)%明顯增加(P=0.049、P=0.000);Cleaved-caspase3蛋白水平(2.01±0.21,2.68±0.28)較對照組(1.00±0.00)上調(diào)(P=0.001、P=0.000);抗凋亡蛋白Mcl-1(0.77±0.03,0.61±0.01)、Bcl-2(0.68±0.07,0.48±0.03)較對照組(1.00±0.00)明顯下調(diào)(P=0.000、P=0.000)(P=0.000、P=0.000);與膿毒癥患者存活組比較,膿毒癥患者死亡組中Jurkat細(xì)胞凋亡、Cleaved-caspase3、Mcl-1、Bcl-2變化更加為明顯(P=0.002、P=0.007、P=0.000、P=0.001)。結(jié)論:膿毒癥患者免疫失衡,T淋巴細(xì)胞凋亡增加,T淋巴細(xì)胞數(shù)明顯減少,發(fā)生免疫抑制,且與病情嚴(yán)重程度和預(yù)后密切相關(guān)。
[Abstract]:Aim: to study the changes of T lymphocyte subsets and T lymphocyte apoptosis in peripheral blood of patients with sepsis and its role in immunosuppression and prognosis.Methods: from October 2014 to December 2015, 55 patients with sepsis treated in ICU of the first affiliated Hospital of Chongqing Medical University were collected and followed up for 28 days. According to the different prognosis, they were divided into two groups: survival group of sepsis patients and death group of septic patients.At the same time, 30 healthy volunteers were collected as control group.The T lymphocyte subsets in peripheral blood of patients were detected by flow cytometry, and the correlation between T lymphocyte subsets and APACHE 鈪，

本文編號：1737321