摘要
目的探讨淋巴细胞凋亡在外科危重病患者中的作用机制及其与预后的关系。方法采用流式细胞仪分别测定外科大手术后危重病患者（39例）和正常对照组（30例）外周血淋巴细胞凋亡；采用血细胞分析仪测定淋巴细胞计数，并分析其与继发感染及重症加强治疗病房（ICU）住院时间的关系。结果外科危重病患者淋巴细胞凋亡率高于正常对照组[（10．82±3．32）％比（2．89±1．17）％，P＜0．01），淋巴细胞计数则显著降低[（1．41±1．26）×10^9／L比（2．58±0．62）×10^9／L，P＜0．013。与无感染组比较，继发感染组淋巴细胞凋亡率明显增强（（12．67±3．11）％比（9．24±2．63）％，P＜0．01]，入ICU后1d是否继发感染的两组患者淋巴细胞计数间差异无显著性，但3d和5d时继发感染组淋巴细胞计数则明显低于无感染组[分别为（0．68±0．35）×10^9／L和（0．72±0．40）×10^9／L）比（1．30±1．33）×10^9／L和（1．34±1．11）×10^9／L]，差异均有显著性（P均＜0．05）。外科术后危重病患者的ICU住院时间与淋巴细胞凋亡率呈正相关（r=0．412，P=0．009），与1、3和5d淋巴细胞计数呈负相关，与1d和5d差异均有显著性（r1=0．333，P1=0．039，r3=0．308，P3=0．057；r5=-0．361，P5=0．024）。结论外科危重病患者外周血淋巴细胞凋亡率增强、淋巴细胞计数下降，且与继发感染及ICU住院时间延长相关，有效调控淋巴细胞凋亡可能有助于改善外科术后危重病患者的预后。
Objective To investigate the role and mechanism of lymphocyte apoptosis in post-operative critically ill patients and to determine the effects of lymphocyte apoptosis on the outcome of post-operative critically ill patients. Methods Thirty-nine consecutive post-operative patients admitted to the intensive care unit （ICU） were included in the prospective study. In addition, 30 healthy blood donors were involved for comparison. Early signs of apoptosis were investigated using flow cytometric measurement of Annexin-V binding to the cell surface of peripheral lymphocytes. In patients, absolute lymphocyte counts were measured on day 1, 3 and 5. The correlations of secondary infection and ICU stay duration with lymphocyte apoptosis and lymphocyte counts were determined. Results Post-operative critically ill patients exhibited higher rate of lymphocyte apoptosis than controls ^（10.82±3.32）% vs. （2. 89±1.17）%, P〈0. 013. Meanwhile, lymphocyte counts were decreased significantly in patients compared with healthy individuals [（1.41 ± 1.26） × 10^9/L vs. （2.58 ± 0. 62） × 10^9/L, P 〈 0. 01]. In patients group, rate of lymphocyte apoptosis was significantly higher in patients with secondary infection compared with those without secondary infection [（12. 67±3.11）% vs. （9. 24±2.63）%, P〈0. 011, and lymphocyte counts had no difference on day 1, while on day S and day 5 were decreased significantly in patients with secondary infection compared with those without secondary infection [0.68 ± 0.35） × 10^9/L vs. （1. 30 ± 1.33） × 10^9/L , （0.72 ± 0. 40） ×10^9/L vs. （1.34 ± 1.11 ） × 10^9/L, respectively, both P 〈 0. 05]. ICU stay duration of post-operative patients was positively correlated with rate of lymphocyte apoptosis （r= 0. 412, P= 0. 009） and negatively correlated with day 1, S and 5 lymphocyte counts, significantly correlated with day 1 and day 5 （r1=- 0. 333, r5 =- 0. 361, both P〈0.05）. Conclusion Lymphocyte apoptosis is enhanced in peripheral blood of post-operative critically ill patients and leads to a profound and persistent lymphopenia associated with poor outcome such as secondary infection and delay of ICU stay duration. Further studies are required to examine whether intervention to prevent lymphocyte apoptosis might alter the patientst outcome.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2007年第1期25-27,共3页
Chinese Critical Care Medicine
基金
浙江省教育厅科研基金资助项目（20051908）
关键词
细胞凋亡
淋巴细胞
预后
危重病
apoptosis
lymphocytes
outcome
critical illness
