耿延青　宋于康

[摘要] 目的 探讨脓毒症急性肺损伤（ALI）患者肺泡灌洗液Th17细胞水平的变化及与预后的关系。 方法 选择66例伴ALI脓毒症患者和70例不伴ALI脓毒症患者，比较二者肺泡灌洗液Th17细胞及外周血Th17细胞的表达；并将脓毒症急性肺损伤患者按APACHEⅡ评分分为低危组、中危组和高危组，按预后分为存活组和死亡组，比较组间肺泡灌洗液Th17细胞、外周血Th17细胞及APACHEⅡ评分。 结果 ALI组肺泡灌洗液Th17细胞、外周血Th17细胞均显著高于非ALI组（P<0.05）。高危组肺泡灌洗液Th17细胞、外周血Th17细胞水平均明显高于低危组、中危组（P<0.05）。死亡组肺泡灌洗液Th17细胞、外周血Th17细胞及APACHE Ⅱ评分均明显高于存活组（P<0.05）。Spearman相关分析显示，伴ALI脓毒症患者肺泡灌洗液Th17细胞与外周血Th17细胞呈一致性，并与APACHE Ⅱ评分高度相关。 结论 肺泡灌洗液Th17细胞的表达对脓毒症ALI患者的病情进展及预后有一定的预测价值。

[关键词] 脓毒症；急性肺损伤；Th17细胞；预后

[中图分类号] R563.9 [文献标识码] A [文章编号] 1673-9701（2017）10-0023-03

Study of changes of Th17 cell level in sepsis patients with acute lung injury and its relationship with prognosis

GENG Yanqing SONG Yukang

Intensive Care Unit，Wenling First People 's Hospital in Zhejiang Province，Wenling 317500，China

[Abstract] Objective To investigate the changes of Th17 cell level in sepsis patients with acute lung injury（ALI） and its relationship with prognosis. Methods 66 sepsis patients with ALI and 70 sepsis patients without ALI were enrolled in this study. The expression of Th17 cells in both alveolar lavage fluid and peripheral blood between the two groups was compared. The sepsis patients with acute lung injury were divided into low risk group， middle risk group and high risk group according to APACHE Ⅱ score. The patients were divided into survival group and death group according to the prognosis. The bronchoalveolar lavage fluid Th17 cells， peripheral blood Th17 cells and APACHE Ⅱ score between the groups were compared. Results Th17 cells in alveolar lavage fluid and peripheral blood of ALI group were significantly higher than those of non-ALI group（P<0.05）. The levels of Th17 cells in alveolar lavage fluid and peripheral blood were significantly higher than those in low-risk group and middle-risk group（P<0.05）. The Th17 cells in alveolar lavage fluid and peripheral blood and APACHE Ⅱ score of death group were significantly higher than those of the survival group（P<0.05）. The alveolar lavage fluid Th17 cells were associated with peripheral blood Th17 cells in sepsis patients with ALI by Spearman correlation analysis， and were highly correlated with APACHE Ⅱ score. Conclusion The expression of Th17 cells in alveolar lavage fluid has a certain predictive value in the progression and prognosis of sepsis patients with ALI.

[Key words] Sepsis；Acute lung injury；Th17 cells；Prognosis

膿毒症主要是由感染诱发的全身炎症反应，常继发于创烧伤大手术、感染、休克等情况，发病率高，预后差，死亡率约25%～80%，是导致ICU患者死亡的重要原因[1-2]。脓毒症可诱发急性肺损伤（acute lung injury，ALI），增加死亡危险，传统炎症指标如C 反应蛋白（C reactive protein，CRP）、降钙素原（Procalcitonin，PCT）、抗凝血酶Ⅲ（Antithrombin Ⅲ，AT-Ⅲ）等，虽对脓毒症ALI具有一定的诊断价值，但仍不能作为评估病情变化及预后的特异性指标[3-4]。Th17细胞是最新发现的一种可特异性分泌白细胞介素-17（Interleukin-17，IL-17）的淋巴细胞亚群，研究发现其与幽门螺杆菌（Helicobacter pylori，Hp）、牙周炎、疱疹病毒、寄生虫感染、脆弱类杆菌等疾病的发展有紧密关系[5]。虽然既往有研究指出 Th17细胞可能参与脓毒症的免疫发病机制，并且其在外周血中的表达水平与病情严重性和临床结局关系密切[6]，但目前其对脓毒症ALI的病情和预后的预测价值仍未阐明。本研究在前研究的基础上探讨了肺泡灌洗液Th17细胞水平对预测脓毒症ALI患者病情程度及预后的临床价值，现报道如下。……