多发伤后早期T细胞亚群的变化及其临床意义

Clinical significance of dynamic changes of T lymphocyte subsets in patients with multiple injuries

关键词:  多发伤  T淋巴细胞亚群  免疫抑制

Key words:  multiple injury  T lymphocyte subsets  Immunosuppression

摘要:

［目的］探讨多发伤患者早期T细胞亚群的变化规律以及与多发伤后发生感染和预后的关系。［方法］将120例创伤患者按损伤严重度评分（ISS）分为2组，即严重创伤组（A组，ISS≥32）和非严重创伤组（B组，ISS<16），同时选取健康志愿者40例（C组）。分别检测患者T细胞亚群的值并进行统计学分析。［结果］与C组相比，A组CD3+，CD4+，CD8+，CD4+/CD8+ 比值在第1、3、7天均有十分显著的下降（P<0.01），B组仅CD3+，CD4+ 的水平在伤后第1，3天有显著的下降（P<0.05）。严重多发伤患者伤后第1，3天CD3+，CD4+，CD4+/CD8+ 的值均与ISS值呈负相关。 79例严重多发伤患者中，55~65岁老年组伤后第1，3天的CD3+，CD4+，CD4+/CD8+ 的水平与20~45岁中青年组相比显著降低（P<0.01）；脓毒症组伤后第7天的CD4+/CD8+ 比值与未发生脓毒症组相比也有显著的下降（P<0.01）。［结论］严重多发伤患者在伤后早期存在细胞免疫抑制，老年患者的免疫抑制效应更为明显；同时多发伤后细胞免疫功能下降及发生感染的机率与多发伤的严重程度有密切的关系；CD4+/CD8+ 的值可以作为严重多发伤患者预后的一个评价指标。

Abstract:

［Objective］To observe change of T lymphocyte subsets and its relation with injury severity in patients with severe multiple injuries.［Methods］Patients were divided into three groups by ISS level: severe group (group A, 79 patients, ISS≥32), non-severe group (group B, 41 patients, 8≤ISS<16) and control group (group C, 40 healthy volunteers). T lymphocytes from the peripheral blood of these patients were assessed by quantitative flow cytometry and analyzed by SPSS 16.0. ［Results］CD3+, CD4+ and CD8+ lymphocyte counts and CD4+/CD8+ ratio in group A were significantly lower than those in the group C on the 1st day, 3rd day and 7th day after injury (P<0.01). CD3+, CD4+ lymphocyte counts in group B were significantly lower than those in the group C on the 1st day and 3rd day after injury. CD3+, CD4+ lymphocyte counts and CD4+/CD8+ ratio were all negatively correlated with ISS on the 1st and 3rd day after injury. CD3+, CD4+ lymphocyte counts and CD4+/CD8+ ratio in 55~65 year-old group were significantly lower than those in 24~45 year-old group. CD4+/CD8+ ratio in sepsis group was markly lower than that in no sepsis group. ［Conclusions］There is obviously immunosuppression during the early phase of multiple trauma. The variations of T lymphocyte subsets are collected with injury severity and can help evaluating the prognosis of multiple trauma patients. T cell-mediated suppression of the immune response is more serious in elderly multiple trauma patients. CD4+/CD8+ ratio may be a predictor of the occurrence of sepsis for multiple trauma patients.