創傷患者早期T淋巴細胞亞群的變化及臨床意義

 【摘要】  目的 探討創傷患者早期T細胞亞群的變化規律以及與創傷后發生感染的關系。方法 60例創傷患者按損傷嚴重度評分(ISS)分為2組，即嚴重創傷組(A組，ISS≥16)和非嚴重創傷組(B組，8≤ISS<16)，A、B組在傷后第1、4、7天抽取外周靜脈血2 ml，健康對照組20例(C組)一次性抽取外周靜脈血2 ml，分別檢測各標本T細胞亞群的值并進行統計學分析。結果 A組在傷后的第1、4天CD3+, CD4+，CD4+/CD8+值及第7天CD4+/CD8+值顯著低于C組(P<0.05)，第7天的CD8+值顯著高于C組(P<0.05)，而第1、4天的CD8+及第7天的CD3+, CD4+與C組無統計學差異。B組在傷后的第1、4、7天內CD3+, CD4+,CD8+,CD4+/CD8+值與C組的差異均無統計學意義。此外，A組第7天的CD3+, CD4+比第1天的CD3+, CD4+ 顯著下降(P<0.05)，而B組第4、7天的CD3+, CD4+,CD8+,CD4+/CD8+值與第1天均無統計學差異。A組第1天CD3+、 CD4+、CD4+/CD8+值與ISS呈負相關(P<0.05)，其余的各組值與ISS均無明顯線性相關(P>0.05)。結論 嚴重創傷患者在傷后早期存在細胞抑制，而非嚴重創傷患者無明顯細胞免疫抑制，傷后細胞免疫功能下降及發生感染的機率與創傷的嚴重程度有密切的關系。

     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

　　近年來創傷患者的數量呈明顯的上升趨勢。對創傷患者的救治是急救醫學中的重點和難點之一，其中感染問題成為影響患者預后的主要原因，而創傷后機體受到的免疫抑制越來越受到人們的重視[1]。本文前瞻性觀察我院60例創傷患者的T細胞亞群的變化，對患者創傷后免疫功能的變化規律及與損傷嚴重度的相關性進行研究，以探討創傷后患者發生感染的內部機制。