脓毒症相关急性呼吸窘迫综合征患者T淋巴细胞免疫功能状态研究

Research on the immune function status of T lymphocytes in patients with sepsis-related acute respiratory distress syndrome

摘要:

目的 探讨脓毒症相关急性呼吸窘迫综合征（ARDS）患者T淋巴细胞亚群、CD4⁺T淋巴细胞共信号CD28和CTLA-4表达。方法 选取2022年3月—2022年11月广西医科大学第二附属医院收治的22例脓毒症相关ARDS患者作为病例组，另选取同期该院21例健康志愿者作为对照组。收集所有受试者临床资料；病例组行全身全身感染相关性器官功能衰竭评价系统评分、急性生理学和慢性健康状况评价Ⅱ评分、多器官功能障碍综合征评分、Murray肺损伤评分及早期肺损伤评分；采用流式细胞术检测外周全血及外周血单个核细胞。结果 与对照组比较，病例组CD45⁺、CD3⁺、CD4⁺、CD8⁺T淋巴细胞计数均减少（P <0.05）；CD3⁺、CD4⁺、CD8⁺T淋巴细胞在CD45⁺细胞表达的百分比均降低（P <0.05）。与对照组比较，病例组Th17和Treg细胞在CD4⁺T淋巴细胞表达的百分比均升高（P <0.05）。与对照组相比，病例组CD28在CD4⁺T淋巴细胞表达的百分比降低（P <0.05），病例组CTLA-4在CD4⁺T淋巴细胞表达的百分比升高（P <0.05）。结论 脓毒症相关ARDS患者T淋巴细胞显著减少，CD4⁺T淋巴细胞分化异常，CD4⁺T淋巴细胞共信号CD28和CTLA-4表达失调，提示T淋巴细胞在脓毒症相关ARDS免疫调节中发挥重要作用。

Abstract:

Objective To investigate the T lymphocyte subsets, co-stimulatory molecules CD28 and CTLA-4 expression in CD4⁺ T lymphocytes in patients with sepsis-related acute respiratory distress syndrome (ARDS).Methods A total of 22 patients with sepsis-related ARDS admitted to the Second Affiliated Hospital of Guangxi Medical University from March 2022 to November 2022 were selected as the case group, while 21 healthy volunteers from the same hospital during the same period were recruited as the control group. The case group underwent various scoring assessments, including the systemic infection-related organ failure assessment, acute physiology and chronic health evaluation Ⅱ, multiple organ dysfunction syndrome, Murray lung injury score, and early lung injury score. Peripheral whole blood and peripheral blood mononuclear cells were analyzed with flow cytometry.Results Compared with the control group, the case group showed significant reductions in CD45⁺, CD3⁺, CD4⁺, and CD8⁺ T lymphocyte counts (P <0.05). The percentages of CD3⁺, CD4⁺, and CD8⁺ T lymphocytes among CD45⁺ cells were also decreased in the case group (P <0.05). In contrast, the percentages of Th17 and Treg cells among CD4⁺ T lymphocytes were increased in the case group (P <0.05). Additionally, the percentage of CD28 expression in CD4⁺ T lymphocytes was lower in the case group (P <0.05), while the percentage of CTLA-4 expression in CD4⁺ T lymphocytes was higher compared to the control group (P <0.05).Conclusions Patients with sepsis-related ARDS exhibit significant reductions in T lymphocyte counts, abnormal differentiation of CD4⁺ T lymphocytes, and dysregulated co-stimulatory molecule expression of CD28 and CTLA-4 in CD4⁺ T lymphocytes. These findings suggest that T lymphocytes play a critical role in immune regulation in sepsis-related ARDS.