肺泡灌洗液Th17细胞水平对脓毒症急性肺损伤患儿预后的影响

熊燚; 王健; 魏笛; 赵君; 叶梅

doi:10.7499/j.issn.1008-8830.2015.09.011

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中国当代儿科杂志 ›› 2015, Vol. 17 ›› Issue (9) : 942-945. DOI: 10.7499/j.issn.1008-8830.2015.09.011

论著·临床研究

肺泡灌洗液Th17细胞水平对脓毒症急性肺损伤患儿预后的影响

熊燚, 王健, 魏笛, 赵君, 叶梅

作者信息 +

Prognostic values of Th17 cells level in bronchoalveolar lavage fluid in children of sepsis with acute lung injury

XIONG Yi, WANG Jian, WEI Di, ZHAO Jun, YE Mei

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文章历史 +

摘要

目的研究脓毒症急性肺损伤患儿肺泡灌洗液Th17 细胞水平的变化及与预后的关系。方法以50 例脓毒症急性肺损伤患儿为研究对象,采用流式细胞仪检测肺泡灌洗液Th17 细胞比例,同时在入院24 h内对患儿进行小儿危重病例评分(PCIS)。按PCIS 评分分为极危重组、危重组及非危重组;根据临床预后分为存活组及死亡组;分别比较Th17 细胞在各组的差异及其与PCIS 分数的相关性。结果随着病情危重程度的增加,肺泡灌洗液中Th17 细胞水平逐渐增高,差异有统计学意义(P<0.05)。Th17 细胞水平与PCIS 评分呈负相关(r=-0.853,P<0.01)。死亡患儿Th17 细胞水平显著高于存活患儿,PCIS 评分低于存活患儿(P<0.05)。结论脓毒症急性肺损伤患儿肺泡灌洗液中Th17细胞水平的增加与其病情严重程度及预后密切相关,提示其可作为病情严重程度及预后的预测指标。

Abstract

Objective To observe the changes in Th17 cell levels in bronchoalveolar lavage fluid in children of sepsis with acute lung injury and the relationship between the Th17 cell levels and prognosis.Methods Fifty children of sepsis with acute lung injury were enrolled in the study. The percentages of Th17 cells in bronchoalveolar lavage fluid were measured by flow cytometry. The patients of sepsis with acute lung injury were classified into three groups based on the Pediatric Critical Illness Score (PCIS):extremely critical, critical and non-critical. According to the clinical prognosis, the patients were classified into survical and death groups. Th17 cell levels were compared between the two groups. The relationship between Th17 cell levels and the PCIS scores was analyzed.Results With the increase in the severity of sepsis, Th17 cell levels in bronchoalveolar lavage fluid were gradually increased (P<0.05). The Th17 cell levels were negatively correlated to the PCIS scores (r=-0.853; P<0.01). The Th17 cell levels were significantly higher in the death group than in the survival group. Moreover, compared with the survival group, the PCIS scores were lower in the death group (P<0.05).Conclusions The increased Th17 cell levels in children of sepsis with acute lung injury are closely related to the severity and prognosis of patients, suggesting that Th17 cell levels can be used as a predictor of the severity and prognosis.

导出引用

熊燚, 王健, 魏笛, 赵君, 叶梅. 肺泡灌洗液Th17细胞水平对脓毒症急性肺损伤患儿预后的影响[J]. 中国当代儿科杂志. 2015, 17(9): 942-945 https://doi.org/10.7499/j.issn.1008-8830.2015.09.011

XIONG Yi, WANG Jian, WEI Di, ZHAO Jun, YE Mei. Prognostic values of Th17 cells level in bronchoalveolar lavage fluid in children of sepsis with acute lung injury[J]. Chinese Journal of Contemporary Pediatrics. 2015, 17(9): 942-945 https://doi.org/10.7499/j.issn.1008-8830.2015.09.011

参考文献

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[15] Lin CW, Lo S, Hsu C, et al. T-cell autophagy deficiency increases mortality and suppresses immune responses after sepsis[J]. PLoS One, 2014, 9(7):e102066.[1] 刑柏, 曾琦, 谭世峰, 等. 呼吸指数对严重脓毒症患者预后的评估价值[J]. 中国全科医学, 2013, 16(7B):2398-2400.
[2] Ganjalikhani Hakemi M, Ghaedi K, Homayouni V, et al. Positive and negative regulation of Th17 cell differentiation:evaluating the impact of RORC2[J]. Cell J, 2014, 16(3):343-352.
[3] 姚斌, 李敏, 庞英. 草分枝杆菌对哮喘小鼠CD4⁺CD25⁺ 调节性T 细胞和Th17 细胞平衡的影响[J]. 中国当代儿科杂志, 2013, 15(11):1018-1022.
[4] Irvin C, Zafar I, Good J, et al. Increased frequency of dualpositive TH2/TH17 cells in bronchoalveolar lavage fluid characterizes a population of patients with severe asthma[J]. J Allergy Clin Immunol, 2014, 134(5):1175-1186.
[5] 马丽, 霍建民. Th17+ T 细胞吸烟与慢性阻塞性肺疾病的相关性研究进展[J]. 中华临床医师杂志(电子版), 2013, 7(12):5561-5563.
[6] Brunialti MK, Santos MC, Rigato O, et al. Increased percentages of T helper cells producing IL-17 and monocytes expressing markers of alternative activation in patients with sepsis[J]. PLoS One, 2012, 7(5):e37393.
[7] Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J]. Crit Care Med, 2013, 41(2):580-637.
[8] 马晓春, 王辰, 方强, 等. 急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006) [J]. 中国危重病急救医学, 2006, 18(12):706-710.
[9] Adamzik M, Broll J, Steinmann J, et al. An increased alveolar CD4⁺ CD25⁺ Foxp3+ T-regulatory cell ratio in acute respiratory distress syndrome is associated with increased 30-day mortality[J]. Intensive Care Med, 2013, 39(10):1743-1751.
[10] 齐英征. 降钙素原与小儿危重病例评分对脓毒症患儿预后的影响[J]. 中国当代儿科杂志, 2014, 16(2):190-193.
[11] 周光耀, 张明, 金玲湘, 等. 前降钙素原和C 反应蛋白对脓毒症早期诊断及预后评估的临床价值[J]. 中华医院感染学杂志, 2014, 24(4):1027-1029.
[12] 张育才. 儿科脓毒症的定义及诊断[J]. 中国实用儿科杂志, 2011, 26(12):883-884.
[13] Lubberts E. Role of T lymphocytes in the development of rheumatoid arthritis. implications for treatment[J]. Curr Pharm Des, 2014, 21(2):142-146.
[14] Akinosoglou K, Alexopoulos D. Use of antiplatelet agents in sepsis:a glimpse into the future[J]. Thromb Res, 2014, 133(2):131-138.
[15] Lin CW, Lo S, Hsu C, et al. T-cell autophagy deficiency increases mortality and suppresses immune responses after sepsis[J]. PLoS One, 2014, 9(7):e102066.