Treg/Th17失衡在脓毒症发病机制中的作用

目的: 观察脓毒症患者外周血中CD4⁺CD2⁺CD127^-调节性T细胞(Treg)及辅助性T细胞17(Th17)的比例,并探讨Treg/Th17失衡在脓毒症发病中的作用。方法: 选择2010年1~8月入住我院ICU的脓毒症患者70例,按疾病严重程度分为脓毒症组(34例)、重症脓毒症组(21例)和脓毒症休克组(15例)。第1 d抽取外周血,应用流式细胞术检测不同组别患者外周血中Treg/Th17比例及CD14单核细胞 HLA-DR表达率,并探讨Treg/Th17比例与免疫状态及病情严重程度(APACHEⅡ评分)的关系。选取同期健康查体者为对照组(30例)。结果: (1) 和对照组相比,各病例组外周血Treg及Th17比例均明显升高(均P<0.01),但升高的程度不同。Th17表达以重症脓毒症组升高最明显,Treg表达以脓毒症休克组升高最明显。(2)Treg/Th17:脓毒症休克组>重症脓毒症组>脓毒症组,各组两两相比均有显著差异(均P<0.01)。脓毒症组Treg/Th17显著低于对照组(P<0.01),脓毒症休克组Treg/Th17显著高于对照组(P<0.01),但重症脓毒症组Treg/Th17与对照组比较无明显差异。(3)CD14单核细胞HLA-DR表达率:脓毒症休克组<重症脓毒症组<脓毒症组<对照组,两两比较均有显著差异(均P<0.01)。(4)Th17比例和APACHEⅡ评分及 HLA-DR表达率无相关性;Treg表达率和APACHEⅡ评分正相关(r=0.93, P<0.01),和HLA-DR表达率负相关(r=-0.89, P<0.01);HLA-DR表达率和APACHEⅡ评分负相关(r=-0.91, P<0.01)。结论: (1)脓毒症患者中Treg和Th17比例失调,Treg/Th17的失衡参与脓毒症的发病及进展。(1)Treg表达率可以在一定程度上反映机体病情及免疫状态。

Effect of disequilibrium of Treg/Th17 in pathogenesis of sepsis

AIM: To investigate the disequilibrium of regulatory T-lymphocytes(Treg) T helper 17 cells(Th17) in sepsis.METHODS: Seventy sepsis patients hospitalized in our ICU during January 2010 to August 2010 were enrolled in the study and divided into sepsis group(n=34),severe sepsis group(n=21) and septic shock group(n=15) based on the severity.Serum samples were collected from all the patients on the first day.The percentages of Th17 and Treg and HLA-DR expression in CD14 monocytes were determined by flow cytometr...