创伤患者早期T淋巴细胞亚群的变化及临床意义
【摘要】 目的 探讨创伤患者早期T细胞亚群的变化规律以及与创伤后发生感染的关系。方法 60例创伤患者按损伤严重度评分(ISS)分为2组，即严重创伤组(A组，ISS≥16)和非严重创伤组(B组，8≤ISS<16)，A、B组在伤后第1、4、7天抽取外周静脉血2 ml，健康对照组20例(C组)一次性抽取外周静脉血2 ml，分别检测各标本T细胞亚群的值并进行统计学分析。结果 A组在伤后的第1、4天CD3+, CD4+，CD4+/CD8+值及第7天CD4+/CD8+值显著低于C组(P<0.05)，第7天的CD8+值显著高于C组(P<0.05)，而第1、4天的CD8+及第7天的CD3+, CD4+与C组无统计学差异。B组在伤后的第1、4、7天内CD3+, CD4+,CD8+,CD4+/CD8+值与C组的差异均无统计学意义。此外，A组第7天的CD3+, CD4+比第1天的CD3+, CD4+ 显著下降(P<0.05)，而B组第4、7天的CD3+, CD4+,CD8+,CD4+/CD8+值与第1天均无统计学差异。A组第1天CD3+、 CD4+、CD4+/CD8+值与ISS呈负相关(P<0.05)，其余的各组值与ISS均无明显线性相关(P>0.05)。结论 严重创伤患者在伤后早期存在细胞抑制，而非严重创伤患者无明显细胞免疫抑制，伤后细胞免疫功能下降及发生感染的机率与创伤的严重程度有密切的关系。
Variation and significance of T lymphocyte subsets early in patients with trauma GAN leilei, LV Dechao, WANG Jiabao.(Department of Emergency Surgery,Anhui Provincial Hospital,Hefei 230001, China)
【Abstract】 Objective To study the change of T lymphocyte subsets and its relation with infection after trauma.Methods 60 traumatic victims is divided into two groups by ISS:a severe traumatic group (group A，ISS≥16) and a nonsevere traumatic group (group B，8≤ISS<16). T lymphocytes from the peripher blood of 60 patients with trauma on the 1st day,4th day,7th day and 20 health control subjects(group C) were assessed by quantitative flow cytometry and analyzed by SPSS.Results CD3+, CD4+ lymphocyte counts on the 1st day,4th day and CD4+/CD8+ value on the 1st day,4th day,7th day were significantly lower in group A than in the control subjects(P<0.05). The difference between CD8+ lymphocyte counts on the 4th day, CD3+, CD4+ lymphocyte counts on the 7th day in group A and in group C was insignificant(P>0.05).Compared to group C, CD8+ lymphocyte counts on the 7th day indecreased significantly(P<0.05). Compared to the 1st day in group A,CD3+,CD4+ lymphocyte counts decreased significantly(P<0.05). The difference of T lymphocyte counts between group B and group C was insignificant(P>0.05). CD3+, CD4+ lymphocyte counts and CD4+ /CD8+ value on the 1st day negatively correlated with ISS (P< 0.05).Conclusion The severe traumatic patients are in cellular immunosuppression early after trauma and the nonsevere traumatic patients are not obvious. The intensity of cellular immune function decline and the severity of the illness are closely correlated.
【Key words】 Trauma; T lymphocyte subsets; Immunosuppression
近年来创伤患者的数量呈明显的上升趋势。对创伤患者的救治是急救医学中的重点和难点之一，其中感染问题成为影响患者预后的主要原因，而创伤后机体受到的免疫抑制越来越受到人们的重视[1]。本文前瞻性观察我院60例创伤患者的T细胞亚群的变化，对患者创伤后免疫功能的变化规律及与损伤严重度的相关性进行研究，以探讨创伤后患者发生感染的内部机制。
