CAJ | 학술논문

目的：探讨脓毒症患儿血清降钙素原（PCT）水平与其T细胞亚群选择性缺失的关系，并阐明二者在早期判断儿童脓毒症严重程度上的意义。方法依据2005年国际儿科脓毒症联席会议标准及小儿危重病例评分法（PCIS）将2013年6月至2014年3月该科收治的70例脓毒症患儿分为非危重组37例（PCIS＞80分）和危重组33例（PCIS≤80分）。另同期选择30例健康儿童作为健康对照组。采用流式细胞仪检测各组儿童T细胞亚群，应用免疫发光分析法检测儿童血清PCT水平，比较PCT水平与T细胞亚群及其选择性缺失的关系。分析血清PCT水平与T细胞亚群选择性缺失在早期评估儿童脓毒症严重程度上的意义。结果与健康对照组比较，非危重组出现CD3+T、CD4+T表达率及CD4+T/CD8+T比值下降；与非危重组比较，危重组CD3+T、CD4+T、CD8+T、CD56+T表达率及CD4+T/CD8+T比值均下降，差异均有统计学意义（P＜0.05或0.01）。脓毒症患儿血清PCT水平与CD3+T、CD4+T、CD19+T表达率及CD4+T/CD8+T校正值呈负相关（P＜0.05或0.01）；PCT水平和CD19+T表达率与患儿PCIS评分呈负相关（P＜0.01），而CD3+T、CD4+T、CD8+T、CD56+T表达率及CD4+T/CD8+T校正值与PCIS评分呈正相关（P＜0.05或0.01）。结论脓毒症患儿T细胞亚群呈选择性缺失，CD4+/CD8+失衡程度与血清PCT水平呈负相关，二者与儿童脓毒症的严重程度密切相关，可作为早期判断脓毒症严重程度的指标。
목적：탐토농독증환인혈청강개소원（PCT）수평여기T세포아군선택성결실적관계，병천명이자재조기판단인동농독증엄중정도상적의의。방법의거2005년국제인과농독증련석회의표준급소인위중병례평분법（PCIS）장2013년6월지2014년3월해과수치적70례농독증환인분위비위중조37례（PCIS＞80분）화위중조33례（PCIS≤80분）。령동기선택30례건강인동작위건강대조조。채용류식세포의검측각조인동T세포아군，응용면역발광분석법검측인동혈청PCT수평，비교PCT수평여T세포아군급기선택성결실적관계。분석혈청PCT수평여T세포아군선택성결실재조기평고인동농독증엄중정도상적의의。결과여건강대조조비교，비위중조출현CD3+T、CD4+T표체솔급CD4+T/CD8+T비치하강；여비위중조비교，위중조CD3+T、CD4+T、CD8+T、CD56+T표체솔급CD4+T/CD8+T비치균하강，차이균유통계학의의（P＜0.05혹0.01）。농독증환인혈청PCT수평여CD3+T、CD4+T、CD19+T표체솔급CD4+T/CD8+T교정치정부상관（P＜0.05혹0.01）；PCT수평화CD19+T표체솔여환인PCIS평분정부상관（P＜0.01），이CD3+T、CD4+T、CD8+T、CD56+T표체솔급CD4+T/CD8+T교정치여PCIS평분정정상관（P＜0.05혹0.01）。결론농독증환인T세포아군정선택성결실，CD4+/CD8+실형정도여혈청PCT수평정부상관，이자여인동농독증적엄중정도밀절상관，가작위조기판단농독증엄중정도적지표。
Objective To approach the correlation of selective defects of T cell subgroups and serum procalcitonin con-centration in children with sepsis,and set forth its significance in judgment of the severity degree of sepsis in children at early phase. Methods In line with the standard of International Pediatrics Sepsis Consensus Conference published in 2005 and pedia-tric critical cases scoring method(PCIS),a total of 70 children with sepsis admitted by department of internal pediatrics of Maternal and Child Health Hospital of HuBei Province from June 2013 to March 2014 were divided into the non-critical group(n=37,PCIS>80 points) and the critical group(n=33,PCIS≤80 points). Additionally,another 30 healthy children at the same period were the healthy control group. It adopted flow cytometry (FCM) to detect their T-lymphocyte subgroups of each group and immunolumines-cence analysis to detect serum PCT concentration of children ,then contrasting their correlation. It was analyzed the significance of PCT concentration and selective defects of T cell subgroups in the judgment of the severity of sepsis in children in the early stage. Results Compared with the healthy control group,the percentages of CD3+T,CD4+T and ratio of CD4+T/CD8+T in the non-crit-ical group were decreased. Compared to the non-critical group,all the value of CD3+T,CD4+T,CD8+T,CD56+T and ratios of CD4+T/CD8+T,whose difference had statistical significance(P<0.05 or 0.01). There was a linear negative correlation between the expression rate of CD3+T,CD4+T,CD19+T,the adjusted value of ratio of CD4+T/CD8+T and serum PCT concentration(P<0.05 or 0.01). PCT concentration and expression rate of CD19+T demenstrated a negative correlation with PCIS of children patients ,how-ever,the expression rate of CD3+T,CD4+T,CD8+T,CD56+T and the adjusted value of ratio of CD4+T/CD8+T were positively correlated with PCIS(P<0.05 or 0.01). Conclusion T cell subgroups in children with sepsis showed selective defects,the imbal-ance of CD4+T/CD8+T was negatively correlated with serum PCT concentration ,both of which had a close relation with sepsis in children,being indicators judging the severity degree of sepsis in children in the early stage.