中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2010年
8期
617-620
,共4页
呼邦传%孙仁华%徐云祥%杨向红%李茜%韩芳
呼邦傳%孫仁華%徐雲祥%楊嚮紅%李茜%韓芳
호방전%손인화%서운상%양향홍%리천%한방
T淋巴细胞,调节性%叉头转录因子类%休克,脓毒症
T淋巴細胞,調節性%扠頭轉錄因子類%休剋,膿毒癥
T림파세포,조절성%차두전록인자류%휴극,농독증
T-lymphocytes,regulatory%Forkhead transcription factors%Shock,septic
目的 探讨老年脓毒症休克患者CD4+CD25+调节性T淋巴细胞(CD4+CD25+Treg)的变化及对预后的影响.方法 选择老年脓毒症休克患者75例,采用流式细胞仪检测患者外周血第1、4天和第7～10天CD4+CD25+叉头转录基因P3(FoxP3)/CD4+比例和白细胞DR抗原(HLA-DR)表达.结果 老年脓毒症休克患者平均年龄(69.2±7.5)岁,28 d病死率为53.3%.(1)休克死亡组与生存组CD4+CD25+FoxP3/CD4+比较,第1天(1.76±0.31)对(1.68±0.24)%,第4天(1.94±0.32)%对(1.82±0.28)%,差异均无统计学意义(P＞0.05),第7～10天休克死亡组(2.65±0.28)%,明显高于存活组(1.79±0.27)%,差异有统计学意义(t=11.30,P＜0.01);(2)死亡组第4天和第7～10天HLA-DR表达持续低下,显著低于生存组(t=7.29,t=16.80,均P＜0.01),并分别与CD4+CD25+FoxP3/CD4+比例呈显著负相关(r=-0.39,P＜0.05;r=-0.58,P＜0.01);(3)多元Logistic回归分析显示,脓毒症休克患者第7～10天CD4+CD25+FoxP3/CD4+(OR=3.47,95%CI:1.33～10.0)和HLA-DR(OR=0.27,95%CI:0.14～0.73)是影响其死亡的独立危险因素.结论 老年脓毒症休克患者CD4+CD25+Treg持续上升,提示机体免疫功能抑制,脓毒症休克死亡的危险性增加.
目的 探討老年膿毒癥休剋患者CD4+CD25+調節性T淋巴細胞(CD4+CD25+Treg)的變化及對預後的影響.方法 選擇老年膿毒癥休剋患者75例,採用流式細胞儀檢測患者外週血第1、4天和第7～10天CD4+CD25+扠頭轉錄基因P3(FoxP3)/CD4+比例和白細胞DR抗原(HLA-DR)錶達.結果 老年膿毒癥休剋患者平均年齡(69.2±7.5)歲,28 d病死率為53.3%.(1)休剋死亡組與生存組CD4+CD25+FoxP3/CD4+比較,第1天(1.76±0.31)對(1.68±0.24)%,第4天(1.94±0.32)%對(1.82±0.28)%,差異均無統計學意義(P＞0.05),第7～10天休剋死亡組(2.65±0.28)%,明顯高于存活組(1.79±0.27)%,差異有統計學意義(t=11.30,P＜0.01);(2)死亡組第4天和第7～10天HLA-DR錶達持續低下,顯著低于生存組(t=7.29,t=16.80,均P＜0.01),併分彆與CD4+CD25+FoxP3/CD4+比例呈顯著負相關(r=-0.39,P＜0.05;r=-0.58,P＜0.01);(3)多元Logistic迴歸分析顯示,膿毒癥休剋患者第7～10天CD4+CD25+FoxP3/CD4+(OR=3.47,95%CI:1.33～10.0)和HLA-DR(OR=0.27,95%CI:0.14～0.73)是影響其死亡的獨立危險因素.結論 老年膿毒癥休剋患者CD4+CD25+Treg持續上升,提示機體免疫功能抑製,膿毒癥休剋死亡的危險性增加.
목적 탐토노년농독증휴극환자CD4+CD25+조절성T림파세포(CD4+CD25+Treg)적변화급대예후적영향.방법 선택노년농독증휴극환자75례,채용류식세포의검측환자외주혈제1、4천화제7～10천CD4+CD25+차두전록기인P3(FoxP3)/CD4+비례화백세포DR항원(HLA-DR)표체.결과 노년농독증휴극환자평균년령(69.2±7.5)세,28 d병사솔위53.3%.(1)휴극사망조여생존조CD4+CD25+FoxP3/CD4+비교,제1천(1.76±0.31)대(1.68±0.24)%,제4천(1.94±0.32)%대(1.82±0.28)%,차이균무통계학의의(P＞0.05),제7～10천휴극사망조(2.65±0.28)%,명현고우존활조(1.79±0.27)%,차이유통계학의의(t=11.30,P＜0.01);(2)사망조제4천화제7～10천HLA-DR표체지속저하,현저저우생존조(t=7.29,t=16.80,균P＜0.01),병분별여CD4+CD25+FoxP3/CD4+비례정현저부상관(r=-0.39,P＜0.05;r=-0.58,P＜0.01);(3)다원Logistic회귀분석현시,농독증휴극환자제7～10천CD4+CD25+FoxP3/CD4+(OR=3.47,95%CI:1.33～10.0)화HLA-DR(OR=0.27,95%CI:0.14～0.73)시영향기사망적독립위험인소.결론 노년농독증휴극환자CD4+CD25+Treg지속상승,제시궤체면역공능억제,농독증휴극사망적위험성증가.
Objective To investigate the changes of CD4+CD25+ regulatory T (Treg) cells in elderly patients with septic shock, and to evaluate the effects of the changes on 28-day mortality rate.Methods The 75 consecutive elderly patients with septic shock were recruited from December 2006to December 2008, and the general states and clinical characteristics of them were analyzed. The CD4+ CD25+ FoxP3 regulatory T cells and human leucocyte antigen DR (HLA-DR) were measured by flow cytometer at the 1st, 4th and 7-10th day of septic shock after being diagnosed. Results The patients were at an average age of (69.2±7.5) years, and the 28-day mortality rate was 53.3%.There were no significant differences in the percentage of CD4 + CD25+ FoxP3/CD4+T cells between the survivors and the non-survivors at the 1st day (1.76 % ±0.31% vs. 1.68 %±0.24 %, P＞0.05)and the 4th day (1.94%±0.32% vs. 1.82% ±0.28%, P＞0.05). However, compared with the survivors, non-survivors had a higher percentage of CD4+ CD25+ FoxP3/CD4+ T cells (2.65%±0.28% vs. 1.79%±0.27%, P＜0.01) at the 7-10th day of septic shock after being diagnosed.Furthermore, from the 4th day to the 7-10th day, the expressions of monocyte HLA-DR in the nonsurvivors were significantly lower than in the survivors (P＜0. 01), and they were inversely correlated with the percentage of CD4+ CD25+ FoxP3/CD4+ T cells at the 4th day (r=-0.39, P=0.023) and the 7-10th day (r= -0. 58, P＜0. 01) respectively. The multiple logistic regression analysis showed that the percentages of CD4+ CD25+ FoxP3/CD4+ T cells (OR = 3.47, 95% CI: 1.33-10.0) and HLA-DR (OR= 0. 27, 95% CI: 0.14-0.73) were independent predictors of 28-day mortality rate.Conclusions Persistent higher percentage of CD4+ CD25+ Treg cells in the elderly patients with septic shock indicates that the patients are under the states of immunosuppression and have a higher risk ofmortality in intensive care unit at admission.
