连续血液净化对严重脓毒症患儿T细胞亚群的影响

Impact of continuous blood purification on T cell subsets in children with severe sepsis

摘要:

目的 探讨连续血液净化（CBP）治疗对严重脓毒症患儿T 细胞亚群及预后的影响。方法 选择严重脓毒症患儿42 例，随机给予常规治疗（对照组，22 例）和常规治疗⁺CBP 治疗 （CBP 组，20 例），分别于治疗前及治疗后3 d、7 d 动态测定外周血调节性T 细胞亚群的变化及相关临床指标。结果 CBP 组患儿PICU 入住时间及机械通气时间均明显短于对照组（均P<0.05）；CPB 组28 d 病死率显著低于对照组（P<0.05）。CPB 组治疗后3 d 和7 d CD3⁺、CD4⁺、CD8⁺ T 淋巴细胞百分比及PCIS 评分较治疗前明显升高，差异均有统计学意义（P<0.05）。CPB 组治疗后3 d CD3⁺、CD4⁺、CD8⁺ T 淋巴细胞百分比及PCIS 评分明显高于对照组（P<0.05）；治疗后7 d CD3⁺、CD4⁺、CD8⁺ T 淋巴细胞百分比、CD4⁺/CD8⁺ 比值及PCIS 评分均较对照组明显升高（P<0.05）。结论 CBP 治疗可以提高严重脓毒症患儿受抑制的免疫功能，改善患儿预后。

Abstract:

Objective To investigate the impact of continuous blood purification (CBP) on T-cell subsets and prognosis in children with severe sepsis. Methods A total of 42 children with severe sepsis were randomly divided into a control group (n=22) and a CBP group (n=20). The patients in the control group received conventional treatment, while those in the CBP group underwent continuous veno-venous hemofiltration daily 12-24 hours for 3 days besides conventional treatment. Changes in clinical variables and in peripheral blood regulatory T cell subsets were assessed 3 and 7 days after treatment. Results The pediatric intensive care unit length of stay and duration of mechanical ventilation were significantly shortened and the 28-day mortality rate was significantly lower in the CPB treatment group as compared with the control group (P<0.05). In the CBP treatment group, the percentage of CD3⁺, CD4⁺, CD8⁺ T cell populations and PCIS scores were significantly higher at 3 and 7 days after treatment than before treatment (P<0.05). At 7 days after treatment, the percentage of CD3⁺, CD4⁺, CD8⁺ T cell populations, CD4⁺/CD8⁺ ratio and PCIS scores were significantly higher in the CBP group than in the control group (P<0.05). Conclusions The CBP treatment may counteract the suppression of immune function and thus improve prognosis in children with severe sepsis.