连续性肾替代治疗对脓毒症患者CD8+T淋巴细胞功能的影响

Effect of continuous renal replacement therapy on the function of CD8+ T lymphocytes in patients with sepsis

摘要:

目的了解脓毒症患者经连续性肾脏替代治疗（CRRT）后外周血CD8+T淋巴细胞数量变化以及对免疫功能的影响。方法收集2015年10月—2016年8月入住某院急诊科的脓毒症住院患者的一般资料，并采集经单次CRRT前后脓毒症患者外周血，分别检测总CD8+T细胞的数量、分泌干扰素γ（IFNγ）的CD8+T细胞数、CD8+T细胞产生抑制性分子水平、共刺激性分子水平以及分泌IFNγ、肿瘤坏死因子α（TNFα）水平。结果共有37例脓毒症住院患者，所有患者均为革兰阴性（G-）菌感染，感染的细菌种类为肺炎克雷伯菌（22株）、鲍曼不动杆菌（11株）、阴沟肠杆菌（3株）。脓毒症患者经CRRT后体温、心率、白细胞计数、尿素氮、血肌酐水平较治疗前下降（均P＜0.05）。经CRRT后脓毒症患者总CD8+T细胞数量较治疗前无明显变化（P＞0.05），但分泌IFNγ的CD8+T细胞的数量较治疗前升高（P＜0.05）。同时，经CRRT后CD8+T细胞产生抑制性分子细胞毒T淋巴细胞相关抗原4（CTLA4）、程序性死亡受体1（PD1）、含T细胞免疫球蛋白及黏蛋白结构域的分子3（TIM3）的水平均较治疗前降低（均P＜0.05），而产生共刺激分子CD28、分泌IFNγ的水平较治疗前升高（均P＜0.05）。结论CRRT不但有效改善脓毒症患者的生命体征和肾功能，还可增强CD8+T细胞免疫功能。

Abstract:

ObjectiveTo investigate the changes in CD8+ T lymphocyte count and effect on immune function in patients with sepsis after continuous renal replacement therapy (CRRT).MethodsGeneral data of septic patients who admitted to the emergency department of a hospital between October 2015 and August 2016 were collected, peripheral blood was taken from patients before and after single CRRT, the total CD8+T cell count, interferonγ（IFNγ）secreting CD8+ T cell count, the levels of inhibitory molecules and costimulatory molecules as well as IFNγ and tumor necrosis factorα（TNFα）produced by CD8+ T cells were detected.ResultsA total of 37 hospitalized septic patients were infected with gramnegative bacteria, pathogens causing infection were Klebsiella pneumoniae (22 strains), Acinetobacter baumannii (11 strains), and Enterobacter cloacae (3 strains). After CRRT, the body temperature, heart rate, white blood cell count, urea nitrogen, and serum creatinine levels in septic patients were all lower than those before CRRT (all P<0.05). After CRRT, the total CD8+ T cell count in septic patients didn’t change significantly (P>0.05), but IFNγsecreting CD8+ T cell count increased (P<0.05). Levels of cytotoxic T lymphocyteassociated antigen 4(CTLA4）, programmed death1 (PD1), Tcell immunoglobulin and mucindomaincontaining molecule 3 (TIM3) after CRRT were all lower than those before CRRT (all P<0.05), while levels of costimulatory molecules CD28 and secreting IFNγ elevated after CRRT(all P<0.05).ConclusionCRRT can not only improve the vital signs and renal function of patients with sepsis, but also enhance the immune function of CD8+ T cells.