杨卫星　　黄君　　娄敏娟　　林荣海

[關键词] Th1/Th2;细胞因子;脓毒症;临床价值

[中图分类号] R631          [文献标识码] B          [文章编号] 1673-9701（2021）16-0056-04

Changes and clinical value of Th1/Th2 and its cytokines in patients with sepsis

YANG Weixing1   HUANG Jun2   LOU Minjuan1   LIN Ronghai1

1.Department of Critical Care Medicine， Taizhou Hospital of Zhejiang Province， Taizhou   317000， China; 2.Department of Neonatology， Taizhou Hospital of Zhejiang Province， Taizhou   317000， China

[Abstract] Objective To investigate the changes and clinical value of Th1/Th2 and its cytokines in patients with sepsis. Methods A total number of 320 patients with sepsis treated in our hospital from January 2017 to December 2019 were selected as the observation group， and 300 healthy people were selected during the same period as the control group. The observation group were divided into 2 subgroups according to the acute physiology and chronic health APACHE-Ⅱ score. Patients with APACHE-Ⅱ score <20 were classified as the non-critical subgroup（192 patients）， and patients with APACHE-Ⅱ score ≥20 were classified as the critical subgroup （128 patients）. The general clinical data of the two groups were collected. The serum levels of Th1， Th2， IFN-γ， and IL-4 in the observation group were compared with those in the control group before and after treatment. Results The general clinical data of the two groups were not significantly different （P>0.05）. Before treatment， the Th1 proportion， Th1/Th2 ratio， IFN-γ level， and IFN-γ/IL-4 ratio in the observation group were significantly lower than those in the control group; the Th2 proportion and IL-4 level in the observation group were significantly higher than those in the control group. After treatment， the Th1 proportion， Th1/Th2 ratio， IFN-γ level， and IFN-γ/IL-4 ratio in the observation group were significantly increased， but still lower than those in the control group; the Th2 proportion and IL-4 level in the observation group were significantly decreased， but still higher than those in the control group. Before treatment， the Th1 proportion， Th1/Th2 ratio， IFN-γ level， and IFN-γ/IL-4 ratio in the critical subgroup were significantly lower than those in the non-critical subgroup; the Th2 proportion and IL-4 level in the critical subgroup were significantly higher than those in the non-critical subgroup. After treatment， the Th1 proportion， Th1/Th2 ratio， IFN-γ level， IFN-γ/IL-4 ratio in the critical subgroup were significantly increased， but still lower than those in the non-critical subgroup; the Th2 proportion and IL-4 level in the critical subgroup were significantly decreased， but still higher than those in the non-critical subgroup. Conclusion Patients with sepsis have decreased Th1/Th2 ratio and IFN-γ/IL-4 ratio. As the disease worsens， such ratios decrease more significantly， and immune function is suppressed. After treatment， the conversion of Th1 to Th2 is corrected. The Th1/Th2 ratio can be used to determine immune status.

[Key words] Th1/Th2; Cytokines; Sepsis; Clinical value

脓毒症可引发休克、多器官功能衰竭，甚至死亡[1-3]。脓毒症死亡的患者脾脏内出现大量凋亡的T淋巴细胞，T淋巴细胞数目及功能显著下降[4]。机体免疫系统内CD4+T淋巴细胞重要的一个亚群是辅助性T细胞（helper T cell，Th细胞），根据细胞的具体功能又分为Th1细胞、Th2细胞，共同反映免疫系统的功能状况[5]，Th1分泌的细胞因子主要有γ-干扰素（interferon-γ， IFN-γ）、白细胞介素-2（interleukin-2， IL-2），Th2分泌的细胞因子主要有白细胞介素-4（interleukin-4， IL-4）、白细胞介素-10（interleukin-10， IL-10）。机体炎症反应-抗炎反应的免疫平衡基础是Th1/Th2平衡，Th1/Th2、IFN-γ/ IL-4可对机体的免疫功能产生重要影响[7]。本课题旨在研究Th1/Th2及其细胞因子在脓毒症患者中的改变和临床价值，现报道如下。

1 资料与方法

1.1临床资料

选择2017年1月至2019年12月我院治疗的脓毒症患者进行研究，纳入标准：均符合由《中国严重脓毒症/脓毒症性休克治疗指南（2014版）》拟定的脓毒症临床诊断标准[8];年龄为18～75岁;发病24 h内入院。排除标准：患有恶性肿瘤;合并心、肝、肾、肺等其他重要器官的功能受损;患者生命体征不稳定或有休克风险;有慢性感染性疾病、传染性疾病、免疫性疾病等;近期接受抗生素、激素、免疫调节剂等药物治疗;处于妊娠期、哺乳期;患有精神类疾病，无法配合研究。

根据上述标准，共纳入320例脓毒症患者作为本课题的观察组，选择同时期来我院体检的300例健康人作为对照组。本课题已通过我院医学伦理委员会审议，患者及其家属均签署本研究的知情同意书。……