摘要
[摘要]目的动态观察严重多发伤患者外周血中Th17细胞的变化特点，并探讨其与多发伤患者继发脓毒症之间的关系。方法符合诊断的40例严重多发伤患者作为病例组，根据第5天有无继发感染将其分为脓毒症组（14例）及非脓毒症组（26例）。创伤后的第1、3、5天无菌抗凝抽取静脉血，用流式细胞仪技术检测Th17比率（Th17／CD4）；应用酶联免疫吸附法及电化学发光法分别检测血浆Th17细胞、相关细胞因子IL-17和IL-6的表达水平。第5天采用双抗免疫荧光法定量分析40例患者血浆中降钙素原（PCT）浓度，用流式细胞仪技术检测CD4／CD8，同时监测血白细胞（WBC）水平。选取同期我院查体中心的健康查体者30例作为对照组。结果严重多发伤患者伤后第1、3、5天均有Th17比率及IL-17、IL-6水平的显著升高（均P〈0．01），且最高峰均为第3天。第1天的Th17表达水平和ISS评分、APACHE11评分均呈正相关（均P〈0．01）。第3天Th17比率、IL-17及IL-6水平两两呈正相关（均P〈0．01）。第1天，脓毒症组的Th17表达显著高于非脓毒症组和对照组，差异有统计学意义（P〈0．01）。第5天，脓毒症组的Th17比率、PCT和WBC显著高于非脓毒症组和对照组，CD4／CD8显著低于非脓毒症组及对照组，差异有统计学意义（均P〈0．01）。非脓毒症组和对照组相比，Th17％、CD4／CD8和PCT差异无统计学意义（P〉0．05），而wBC显著高于对照组（P〈0．01）。结论Th17细胞可能通过分泌炎性介质途径，参与多发伤后的炎症反应，并且可以反映炎症反应状态及疾病严重程度。高水平的Th17表达可能参与免疫紊乱的发生，使多发伤患者感染风险增加，和PCT相似，可有助于判断脓毒症的发生。
Objective To observe the change of T help 17 cells （Thl7） dynamically in patients with severe multiple injury and investigate their relation with sepsis following injury. Methods 40 patients were divided into sepsis group （14 patients） and non- sepsis group （26 patients） based on the occurence of sepsis on the five day. Serum samples of patients with severe multiple injury were collected at days 1, 3 and 5 after injury. Flow cytometry（FCM） was used to determine the percentage of Thl7. The concentrations of IL - 17 and IL -6 were measured by enzyme linked immunosorbent assays （ ELISA ） and Electrogenerated chemiluminescence （ ECL ） method respectively. Immunorediometric assay was used to measure the serum PCT level at day 5. Flow cytometry was used to mesure the ratio of CD4/CD8. Thirty healthy individuals that came from the center for examination of our hospital served as controls. Results Compared with the control, the percentage of Thl7 and the concentrations of IL - 17 and IL -6 were singnificently higher at days l, 3 and 5 （ all P 〈 O. 001 ） . The percent age of Thl7showed positive correlation with IL - 17 and IL - 6 （ ＂all P 〈 0.01 ） and all of them reached peak at day 3. The proportion of Thl7 in sepsis group was significantly higher than that in non - sepsis group and control group （ all P 〈 0.0! ） at day 1. The proportion of Thl7, the ratio of CIM/CD8, the level of PCT and IL - 6 in sepsis group was significantly higher than that in non - sepsis group （ P 〈 0.01 ） at day 5. The proportion of Thl7, the ratio of CIM/CD8 and the level of PCT in non - sepsis group showed no singnificent defference with that in control group. The level of WBC was singnificently higher in non -sepsis group than that in control group. The percentage of Thl7 showed negative correlation with score of ISS and APACHE II in patients with severe multiple injury at day 1. Conclusion Maybe Thl7 cells participate in postinjury inflammatory reaction through the secretion of inflammation mediator, the proportion of Thl7 can reflect the condition of inflammation and the Severity of disease. High level of the percentage of Thl7 can result in immunological disorder and then rise the risk of infection. Similar with PCT,the percentage of Thl7 can help judge the occurrence of sepsis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2012年第6期502-505,共4页
Chinese Journal of Critical Care Medicine
