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目的观察脓毒症患者外周血T淋巴细胞亚群水平变化,探讨脓毒症患者外周血T淋巴细胞亚群在发病中作用及预后意义。方法以温州医学院附属第二医院急救中心及急诊ICU2007年8月～2009年7月收治的脓毒症患者64例为研究对象,采用流式细胞仪检测64例脓毒症患者(脓毒症组)入院后第1、7、14天外周血CD3+、CD4+、CD8+T淋巴细胞计数,并按病情好转与未好转分为两组,比较两组的异同。同时以同期20例健康体检者作为健康对照组。结果 2组脓毒症患者第1天CD3+、CD4+T淋巴细胞计数及CD4+/CD8+T淋巴细胞计数比值均明显低于健康对照组(P<0.05),CD8+T淋巴细胞计数比较无明显统计学差异;2组脓毒症患者之间第1天CD3+、CD4+T淋巴细胞计数及CD4+/CD8+T淋巴细胞计数比值存在统计学差异,未好转组明显低于好转组(P<0.05);好转组CD3+、CD4+T淋巴细胞计数及CD4+/CD8+T淋巴细胞计数比值随着治疗时间变化逐渐得到纠正,在第14天时接近健康对照组(P>0.05)。未好转组无明显改变。结论脓毒症患者可以出现免疫失衡,表现为CD3+、CD4+、CD4+/CD8+比值的下降,且其和疾病严重程度存在一定相关性。CD3+、CD4+、CD4+/CD8+比值可以作为脓毒症治疗过程中的疾病严重程度的检测指标。
Objective To observe the changes of T lymphocyte subsets in peripheral blood of patients with sepsis and explore the role and prognostic significance of T lymphocyte subsets in peripheral blood of patients with sepsis. Methods Totally 64 64 patients with sepsis admitted to the Second Affiliated Hospital of Wenzhou Medical College and the emergency ICU from August 2007 to July 2009 were enrolled. Sixty-four sepsis patients (sepsis Group) on the 1st, 7th and 14th day after admission, the numbers of CD3 +, CD4 +, CD8 + T lymphocytes in peripheral blood were counted and divided into two groups according to the improvement of the disease and no improvement. In the meantime, 20 healthy subjects were taken as healthy control group. Results The counts of CD3 +, CD4 + T lymphocytes and the ratio of CD4 + / CD8 + T lymphocytes in sepsis patients on day 1 were significantly lower than those in healthy controls (P <0.05). There was no significant difference in CD8 + T lymphocyte counts There was statistical difference between the two groups of sepsis patients on the first day of CD3 +, CD4 + T lymphocyte count and CD4 + / CD8 + T lymphocyte count ratio was statistically significant difference was significantly lower than the improved group (P <0.05 ). The ratio of CD3 +, CD4 + T lymphocyte count and CD4 + / CD8 + T lymphocyte count in the reformed group was gradually corrected with the change of treatment time, and close to the healthy control group on the 14th day (P> 0.05). No improvement group no significant change. Conclusions Immune imbalance may occur in sepsis patients, showing the decrease of the ratio of CD3 +, CD4 + and CD4 + / CD8 +, and it has some correlation with the severity of the disease. CD3 +, CD4 +, CD4 + / CD8 + ratio can be used as a measure of the severity of the disease during sepsis treatment.