The Role Of Peripheral Blood CD4~+and CD8~+T Lymphocyte In Predicting Persistent Organ Failure In The Early Phase Of Acute Pancreatitis

Objective:To investigate the association between peripheral blood CD4+/CD8+T lymphocyte and severity of severe acute pancreatitis (SAP) in the early phase.Methods:Clinical database including120cases of SAP from Oct2007to Nov2008were analyzed retrospectively. All the participants were adult patients (aged18to70years old) admitted within3days of disease onset without surgical intervention. The patients were divided based on Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score: A group with APACHE Ⅱ score<10(36cases); B group with APACHE Ⅱ score10-19(71cases); C group with APACHE Ⅱ score≥0(13cases). The data of patients’ general condition, biochemical indicators and CD4+/CD8+T lymphocyte count of the1st day after admission were collected for analysis.Results:The clinical data of A, B, C groups were comparable, the peripheral blood CD4+T lymphocyte rate regression coefficient and95%confidence interal (CI) of B and C groups compared with A group were [-4.7(-10.8,1.5),P=0.143] and [8.4(-12.7,29.5),P=0.439], respectively, the peripheral blood CD8+T lymphocyte rate regression coefficient and95%CI of B and C groups compared with A group were[0.9(-3.5,5.2),P=0.699] and [5.5(-9.5,20.5),P=0.476], respectively, the peripheral blood CD4+/CD8+T lymphocyte ratio regression coefficient and95%CI of B and C groups compared with A group were [-0.3(-0.8,0.1),P=0.161] and [-0.2(-1.7,1.3),P=0.770], respectively.Conclusions:Peripheral blood CD4+, CD8+T lymphocyte rate and CD4+/CD8+T lymphocyte ratio is associated with severity of SAP in the early phase. The CD4+/CD8+T lymphocyte ratio is negatively related to the severity of SAP. Objective:Few data are available on the potential role of inflammatory mediators and T lymphocytes in persistent organ failure (POF) in acute pancreatitis (AP). We conducted a retrospective study to characterize their role in the progression of POF in AP.Methods:A total of69AP patients presented within24hours from symptom onset developing organ failure (OF) on admission were included in our study. There were39patients suffering from POF and30from transient OF (TOF). On the1st,3rd and7th days after admission, blood samples were collected for biochemical concentration monitoring including serum IL-1β,IL-6, TNF-a and high-sensitivity C-reactive protein (hs-CRP). The proportions of peripheral CD4+and CD8+T lymphocytes were assessed based on flow cytometry simultaneously.Results:Patients with POF showed a significantly higher value of IL-1β and hs-CRP on day7compared with the group of TOF (P<0.05). Proportions of CD4+T cells on days1,3, 7and CD4+/CD8+ratio on day1were statistically lower in the group of POF patients (P<0.05). A CD4+T cell proportion of30.34%on day1predicted POF with an area under the curve (AUC) of0.798, a sensitivity with61.54%and specificity with90.00%, respectively.Conclusions:The reduction of peripheral blood CD4+T lymphocyte is associated with POF in AP, and may act as a potential predictor. Objective:To investigate the effect of hydroxyethyl starch(HES)130/0.4on peripheral blood CD4+and CD8+T lymphocytes in the early stage of severe acute pancreatitis (SAP).Methods:Clinical data of112case of SAP from Oct2007to Nov2008in Pancreatic Disease Institute of Wuhan Union Hospital were analyzed retrospectively. All patients received conventional treatment without operation. The time from symptom onset to presentation of hospital was within72hours for all patients.53patients received ringer solution for fluid resuscitation only (control group), and59ones received ringer solution plus6%HES130/0.4for fluid resuscitation (observing group). The values of peripheral blood CD4+,CD8+T lymphocytes and CD4+/CD8+T ratios on days1,3and7were measured.Results:There was no significant difference regarding the values of peripheral blood CD4+,CD8+T lymphocytes and CD4+/CD8+T ratios on days1,3and7between the two groups(P>0.05). Similarly, the decline of the values on days3and7from baseline (△was comparable in both two groups (P>0.05).Conclusions:Early fluid resuscitation with HES130/0.4and ringer solution demonstrates no superiority in up-regulating peripheral blood CD4+,CD8+T lymphocytes and CD4+/CD8+T ratios compared with solitary use of ringer solution.