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免疫失衡在重症急性胰腺炎患者继发全身感染中的作用

余杨梓   

  1. 天津医科大学
  • 收稿日期:2012-03-26 修回日期:2012-05-03 出版日期:2012-07-15 发布日期:2012-07-15
  • 通讯作者: 余杨梓

The role of the immune imbalance in patients with severe acute secondary systemic infection

  • Received:2012-03-26 Revised:2012-05-03 Published:2012-07-15 Online:2012-07-15

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摘要： 目的：研究免疫失衡在重症急性胰腺炎患者继发全身感染中的作用。方法：55例重症急性胰腺炎患者分为确诊全身感染组(A组)和可疑全身感染或无全身感染组(B组)。检测入院第1、3、7、10 天的外周血人白细胞DR抗原（HLA-DR），T辅助淋巴细胞1/2（Th1/Th2）比值，调节T细胞（Treg）水平。统计患者住外科重症监护病房（SICU）的天数及28 d病死率。结果：55例患者平均住SICU（9.82±4.32）天，住院（24.72±10.35）天，28d病死率为9.09%（5/55）。A组28d病死率及住外科重症监护病房（SICU）的天数较B组显著增加。A组各时间点HLA-DR均显著低于B组。B组HLA-DR值随时间延长显著升高,A组内无显著差异。两组Th1/Th2值先增高，后降低，A组各时间点均显著低于B组。两组Treg先降低，后增高，各点A组均显著高于B组。全部患者各时间点Th1/Th2值与Treg密切相关。两组住SICU天数，病死率与HLA-DR%显著相关。A组累及脏器数1、3、7天随时间延长显著升高，B组1、3、7、10天随时间延长显著下降，且与HLA-DR、病死率密切相关。结论：全身感染组患者早期即出现抗原呈递作用受阻碍，免疫失衡，增加了机体对内、外源性感染的易感性，机体不能有效清除病原体出现全身感染，延长了住SICU的天数，增加了病死率。

关键词: 免疫失衡, 重症急性胰腺炎, 人白细胞DR抗原（HLA-DR）, 感染, T辅助淋巴细胞1/2（Th1/Th2）, 调节T细胞（Treg）

Abstract: Objective: To study the role of immune imbalance in patients with severe acute pancreatitis secondary to systemic infection. Methods: 55 cases of patients with severe acute pancreatitis was divided into secondary to systemic infection group (A group) and suspected systemic infection with or without systemic infection group (B group).Assayed the level of human leukocyte antigen DR (HLA-DR), T helper lymphocyte 1 / 2 (Th1 / Th2) ratio, the regulation of T cell (Treg) level in peripheral blood on the 1st, 3rd, 7th, 10th day. The mortality rate at 28 days and the length of stay in surgical intensive care unit(SICU)were recorded. Results: In 55 patients, length of SICU stay were(9.82± 4.32) days, length of hospital stay were (24.72±10.35)days, the mortality rate at 28 days was 9.09% (5 / 55). The mortality of Group A was higher than the B group .At each time point, the value of HLA-DR i n A group were significantly lower than B group. Two groups of the Th1 / Th2 value increased firstly, after reducing, at each time point in A group were significantly lower than B group. Two groups of Treg decreased, increased after, the A group were significantly higher than that of B group. All patients at each time point Th1 / Th2 value was closely related to Treg. Two groups of SICU stay stay, mortality significantly associated with HLA-DR%. The number of involved organ was closely related to HLA-DR and the mortality rate ,wich was significantly increased in group A, decreased in group B. Conclusion: The group of patients with systemic infection occurs early antigen presenting function hindrance, immune imbalance, increased body internally, exogenous susceptibility to infection, the body can not effectively remove pathogens ,appearing systemic infection, prolonged SICU stay days, increased the mortality rate.

Key words: Immune imbalance, Severe Acute Pancreatitis, Human Leukocyte Antigen DR (HLA-DR)