摘要
目的 探讨创伤后早期患者外周血中淋巴细胞亚群的变化与创伤严重程度的相关性.方法 选择63例创伤4h内入院的成年男性患者,根据入院时损伤严重度评分（ISS）分为轻伤组（ISS＜16分,35例）和重伤组（ISS≥16分,28例）,于入院时取外周血检测淋巴细胞亚群、血常规、血生化,行动脉血气分析,计算急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分,分析淋巴细胞亚群与ISS评分和APACHEⅡ评分的相关性.另选择20例健康成年男性作为健康对照.结果 与健康对照组相比,轻伤组和重伤组患者血中CD3＋T淋巴细胞明显降低（0.648±0.112、0.647±0.110比0.708±0.082,均P＜0.05）；重伤组患者血中CD4＋T淋巴细胞明显降低（0.317±0.086比0.389±0.064,P＜0.05）,自然杀伤细胞（NK细胞）明显升高（0.217±0.107比0.158±0.068,P＜0.05）.重伤组患者B细胞明显低于轻伤组（0.114±0.060比0.155±0.075,P＜0.05）.健康对照组、轻伤组和重伤组患者间CD8＋、CD4/CD8比值差异均无统计学意义（CD8＋：0.260±0.074、0.260±0.091、0.271±0.105,CD4/CD8比值：1.69±0.75、1.56±0.83、1.34±0.65,均 P0.05）.除重伤组CD3＋T淋巴细胞与ISS评分呈显著负相关（r=-0.42,P=0.03）外,其他淋巴细胞亚群与ISS评分和APACHEⅡ评分均无相关性（轻伤组与ISS评分：CD3＋ r=-0.10,CD4＋r=-0.31,CD8＋ r=0.18,B细胞r=0.20,NK细胞r=-0.04；轻伤组与APACHEⅡ评分：CD3＋ r=0.04, CD4＋ r=-0.07,CD8＋ r=0.06,B细胞r=-0.10,NK细胞r=0.05,均P＞0.05;重伤组与ISS评分：CD4＋ r=-0.12,CD8＋ r=-0.17,B细胞r=0.02,NK细胞r=0.31；重伤组与APACHⅡ评分：CD3＋ r=-0.24,CD4＋ r=0.11,CD8＋ r=-0.26,B细胞r=0.15,NK细胞r=0.08,均P＞0.05）.结论 严重创伤后早期患者血中CD3＋、CD4＋T细胞明显下降、NK细胞明显升高；其中CD3＋是独立的机体损伤指标.应动态监测严重创伤后患者血中免疫细胞的变化.
Objective To investigate the association of traumatic severity with changes in lymphocyte subsets in the early stage after trauma.Methods Sixty-three male patients admitted within 4 hours after trauma were enrolled.According to injury severity score （ISS）,the patients were divided into two groups：mild trauma group （ISS＜ 16,n=35） and severe trauma group （ISS ≥ 16,n =28）.At admission,the patients peripheral blood were extracted to detect T lymphocytes subsets,blood routine test,blood biochemical and arterial blood gas analysis which were used to calculate the acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） scores.The correlation of lymphocyte subsets and ISS score,and the correlation of lymphocyte subsets and APACHE Ⅱ score were both analyzed statistically.Another 20 cases of healthy male adults were enrolled as the control group.Results Compared with the healthy control group,CD3＋ T cell contents in blood were decreased obviously in mild trauma group and severe trauma group （0.648 ± 0.112,0.647 ± 0.110 vs.0.708 ± 0.082,both P＜0.05）; CD4＋ T cells contents in severe group were decreased significandy （0.317 ± 0.086 vs.0.389 ± 0.064,P＜ 0.05）,and natural killer （N K） cells were significantly increased （0.217 ± 0.107 vs.0.158 ±0.068,P＜0.05）.B cells content in severe group was decreased significantly than that of mild group （0.114 ± 0.060 vs.0.155 ± 0.075,P＜0.05）.There were no significant difference in CD8＋ and CD4/CD8 ratio among the healthy control group,mild trauma group and severe trauma group （CD8＋：0.260 ± 0.074,0.260 ± 0.091,0.271 ± 0.105; CD4/CD8 ratio：1.69 ±0.75,1.56 ±0.83,1.34 ±0.65,all P＞0.05）.Except that there were negative correlation between CD3＋ T cells and the ISS scores （r=-0.42,P=0.03）,the other lymphocyte subsets showed no correlation with the ISS scores and the APACHE] scores （mild trauma group with ISS scores：CD3＋ r=-0.10,CD4＋r=-0.31,CD8＋ r=0.18,B cells r=0.20,NK cells r=-0.04; mild trauma group with APACHE Ⅱ scores：CD3＋ r=0.04,CD4＋ r=-0.07,CD8＋ r=0.06,B cells r=-0.10,NK cells r=0.05,severe trauma group with ISS scores：CD4＋r=-0.12,CD8＋ r=-0.17,B cells r=0.02,NK cells r=0.31,all P＞0.05;severe trauma group with APACHE Ⅱ scores：CD3＋ r=-0.24,CD4＋ r=0.11,CD8＋ r=-0.26,B cells r=0.15,NK cells r=0.08,all P＞ 0.05）.Conclusions CD3＋ and CD4＋ T cells decreased and NK cells increased significantly in blood in the early stage after severe trauma.CD3＋ T cells are independent indexes which reflect body injury.Therefore,it is necessary to monitor the changes of immune cells dynamically after severe trauma.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第8期489-492,共4页
Chinese Critical Care Medicine
基金
南京军区科技创新资助项目（09MA036）
江苏省麻醉学重点实验室开放课题（KJS1103）
