作　　者： (王斐）; (缪惠洁）; (王春霞）; (张育才）;

机构地区： 上海市儿童医院上海交通大学附属儿童医院重症医学科,200040

出　　处： 《中国小儿急救医学》 2017年第8期561-565,共5页

摘　　要： 目的探讨儿童严重脓毒症体液免疫、淋巴细胞亚群和NK细胞水平变化，与病情严重程度及预后的关系。方法2013年3月至2017年2月，上海交通大学附属儿童医院重症医学科收治严重脓毒症患儿共224例，其中82例于人PICU24h内和治疗7d后至少2次进行体液免疫（IgG、IgM、IgA）、细胞免疫[淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋、CD19^＋]和NK细胞（CD16^＋56^＋）测定，比较存活组（59例）与死亡组（23例）、不同器官功能状态患儿（累及出现器官功能障碍个数〉3个共36例，2—3个共30例，1个共16例）的免疫功能变化。同期体检儿童15例作为正常对照组。结果（1）严重脓毒症患儿入PICU时血NK细胞明显低于正常，治疗7d后存活组NK细胞数量升高[（3．7±1．9）％比（11．5±1．9）％，P〈0．05]；严重脓毒症组与正常对照组IgG、IgM、IgA比较差异无统计学意义（均P〉0．05），而淋巴细胞亚群中CD3^＋、CD4^＋、CD8^＋细胞比较差异有统计学意义[（62．8±8．5）％比（70．9±2．3）％、（33．3±7．0）％比（39．8±1．8）％、（22．6±2．8）％比（34．8±15．6）％，均P〈0．05]。（2）淋巴细胞亚群CD3^＋、CD4^＋及NK细胞比例随患儿儿童危重病例评分降低、第三代儿童死亡危险评分增高及器官功能障碍数目增多，呈明显下降趋势，差异有统计学意义（P〈0．05），血清IgG、IgM、IgA及CD19^＋细胞变化差异无统计学意义（P〉0．05）。（3）死亡组患儿在入院24h内NK细胞及CD3^＋、CD4^＋细胞水平明显低于存活组[（1．5±0．5）％比（4．7±1．4）％，（55．1±5．0）％比（66．4±7．4）％，（29．7±5．2）％比（35．0±7．2），均P〈0．05]。结论未发现免疫球蛋白水平与严重脓毒症患儿病情严重程度有相关性；NK细胞及CD3^＋、CD4^＋淋巴细胞降低是脓毒症病情加重的标志，可作为评估严重脓毒症患儿� Objective To investigate the association of immunological indicators with the severity and prognosis of pediatric patients with severe sepsis. Methods We enrolled 82 pediatric patients with severe sepsis admitted to pediatric intensive care unit （PICU） at Shanghai Children＇s Hospital between March 2013 and February 2017 as septic group. Fifteen healthy children served as control group. The blood samples were collected within 24 hours after admission and on day 7 after treatment. The levels of immunoglobulin （IgG,IgM and IgA） were analyzed by automatic special protein analyzer, and the proportion of T-lympho- cyte subgroup （CD3＋ ,CD4＋ ,CD8＋ and CD19＋ ） and natural killer （NK） cells （CD16＋ and CD56＋ ） in peripheral blood were detected by flow-cytometry. Restflts The levels of IgG, IgM and IgA had no statistical differences between septic group and control group （P 〉 0. 05 ）. Interestingly, the proportion of NK cells in pe- diatric patients with severe sepsis was significantly lower compared to the control group, and the number of NK cells was significantly increased after 7 days treatment compared with that within 24 hours after admission [ （3.7 ± 1.9） % vs. （ 11.5 ＋ 1.9） %, P 〈 0. 05 ]. In addition, the proportions of T-lymphocyte subgroups in- cluding CD3 ＋ , CD4 ＋ and CD8 ＋ were significantly decreased in patients of septic group compared with control group[ （62. 8 ±8.5）% vs. （70.9±2.3）% ,（33.3 ±7.0）% vs. （39.8 ±1.8）% and（22.6 ±2.8）% vs. （34. 8 ± 15. 6） %, respectively, all P 〈 0. 05 ]. Moreover, the proportions of NK cells, CD3 ＋ and CD4 ＋ T lymphocytes subsets in peripheral blood of patients with severe sepsis were positively associated with pediatric critical illness score（ P 〈 0. 05 ）, and negatively associated with pediatric risk of mortality score Ill and the number of dysfunction organs （ all P 〈 0. 05 ）. Furthermore, the proportions of NK cells and CD3 ＋ and CD4 ＋ T lymphocytes in peripheral blo

关 键 词： 严重脓毒症 免疫球蛋白 淋巴细胞亚群 细胞 儿童