小儿脓毒症T细胞亚群变化分析及临床意义

Changes in T cell subsets in children with sepsis, and their clinical significance

摘要:

目的：通过观察脓毒症患儿T细胞亚群变化及预后，探讨其在脓毒症发生发展中的临床意义。方法：以50 例严重脓毒症患儿和150 例一般脓毒症患儿为研究对象，同时纳入50例非脓毒症儿童为对照组。采用流式细胞仪测定外周血CD3阳性淋巴细胞(CD3+T)、CD4阳性淋巴细胞(CD4+T)和CD8阳性淋巴细胞(CD8+T)百分比及CD4+T／CD8+T比值，并于入院24 h内行小儿危重病例评分（PCIS）。结果：严重脓毒症组患儿CD3+ T、CD4+ T和CD8+ T水平、CD4+ T／CD8+ T比值及PCIS明显低于对照组及一般脓毒症组(P<0.01)。200例脓毒症患儿中，治愈组CD3+ T、CD4+T、CD8+T水平、CD4+T／CD8+T比值及PCIS较死亡组降低(P<0.05)。结论：脓毒症患儿存在着不同程度的细胞免疫功能抑制，其程度与疾病的严重程度有明显的关联。脓毒症患儿外周血T淋巴细胞亚群的检测对评估脓毒症患儿的免疫功能状况和判断病情严重程度具有重要的临床意义。

Abstract:

OBJECTIVE: To observe changes in T cell subsets in children with sepsis and their prognosis, and to investigate the clinical significance of these changes in the occurrence and development of sepsis. METHODS: Fifty children with severe sepsis and 150 children with general sepsis were enrolled as subjects, and 50 age-matched healthy children were included as controls. The percentages of CD3+, CD4+ and CD8+ T cells in peripheral blood and CD4+/CD8+ ratio were measured by flow cytometry. The pediatric critical illness score (PCIS) was calculated within 24 hours of admission. RESULTS: The children with severe sepsis showed significantly lower percentages of CD3+, CD4+ and CD8+ T cells CD4+/CD8+ ratio and PCIS than the controls and children with general sepsis (P<0.01). Among the 200 cases of sepsis, the percentages of CD3+, CD4+ and CD8+ T cells, CD4+/CD8+ ratio and PCIS were significantly lower in the cured group than in the deceased group. CONCLUSIONS: Children with sepsis have different degrees of cellular immunosuppression, and the degree of cellular immunosuppression is significantly correlated with the severity of the disease. Detection of T cell subsets in peripheral blood is of great significance for evaluating immune function and judging disease severity in children with sepsis.