| Objective:Sepsis refers to the life-threatening organ dysfunction syndrome caused by the uncontrolled response to infection in the body,which has always been the research hotspot and focus in the field of intensive care medicine due to its rapid onset and high mortality.Although profound progression has been attained in research on sepsis for over 20 years,its exact pathogenesis remains unknown,and the role of immune dysfunction in the genesis and development of sepsis has attracted increasing attention.This study aimed to investigate the proportions of CD4+T cells and CD8+T cells in total CD3+T cells,as well as the percentages of CD4+T cells in all immune subtypes in the peripheral blood of patients with early sepsis,and to-explore the changes in immune function in the bodyduring the pathogenesis of early sepsis,so as to provide theoretical foundation for understanding the pathogenesis of sepsis,improving the diagnostic and treatment measures,and ultimately enhancing the prognosis for sepsis patients.Method:Patients admitted into the ICU of the first affiliated hospital of JINAN university from August 2017 to August 2018 were included,while those with autoimmune diseases,malignant hematological diseases,tumors,viral hepatitis,syphilis,tuberculosis,HIV infection,and a history of using hormones or immunosuppressive agents in the past 3 months were excluded.A total of 43 adult patients who met the sepsis diagnostic criteria of "Sepsis 3.0" and were diagnosed with sepsis at 48-72 hour after surgery were included in this study,and they were divided into survival group and death group based on whether the patient had survived on day 28 after the diagnosis of sepsis.Meanwhile,the control group was made up of 16 non-septic adult patients who were hospitalized in our ICU during the same period.The proportions of CD4+T cells and CD8+T cells in the total CD3+T cells,together with the percentage distribution of CD4+T with the immune subtypes of cell naive T cells(Tn),central memory T cells(Tcm),effector memory T cells(Tem)and terminally differentiated effector T cells(TEMRA)in the peripheral blood of the above subjects were detected by flow cytometry,and their correlations with the SOFA score and the APACHE ? score were analyzed.Results:1.This study had enrolleda total of 43 patients with sepsis(including 26 males and 17 females' with the mean age of 65.23±16.30years),among then,12 deaths(27.90%mortality)and 31 survivors(72.10%survival)were also included,with the overall APACHE ? score of 20.91 ± 9.992.The proportion of CD3+CD4+T cells in CD3+T cells in the peripheral blood of patients with sepsis was remarkably decreased compared with that in control group(control group:52.57±8.78,sepsis group:23.70±13.33,P<0.001),while the proportion of CD3+CD8+T cells was markedly increased(control group:25.69±5.69,sepsis group:47.57±19.18,P<0.001),and the ratio of CD4+T/CD8+T cells was reduced(control group:2.211±0.87,sepsis group:0.70±0.74,P<0.001),and the difference was statistically significant(P<0.05).There were no significant differencesin the proportions of CD3+CD4+T cells and CD3+CD8+T cells,as well as the CD4+T/CD8+T ratio in the peripheral blood between sepsis death group and sepsis survivor group(P>0.05).Moreover,CD3+CD4+T cells and CD3+CD8+T cells,as well asthe CD4+T/CD8+T ratio were not correlated with the APACHE ? score and the SOFA score(P>0.05).3.The CD4+Tn percentage in the sepsis survivor group was decreased compared with that in control group(control group:54.40±14.01,sepsis survivor group:23.14±14,46,P<0.001),and the CD4+Tn percentage in the sepsis death group was reduced relative to that in control group(control group:54.04±14.01.sepsis death group:31.08±10.81,P=0.020).The CD4+Tcm percentage in the sepsis death group was decreased compared with that in control group(control group:33.61±15.38,sepsis death group:17.78±5.86,P=0.029),the CD4+Tem percentage in the sepsis survivor group was increased relative to that in control group(control group:4.31±2.06,sepsis death group:21.33±9.72,P<0.001),the CD4+Tem percentage in the sepsis death group was increased compared with that in control group(control group:4.31±2.06,sepsis death group:23.69±13.29,P<0.001),the CD4+TEMRA percentage in the sepsis death group was increased compared with that in control group(control group:8.04±3,63,sepsis death group:24.11±18.29,P=0.005),and the percentage of CD4+TEMRA was increased in the sepsis death group compared with that in control group(control group:8.04±3.63,sepsis death group:2 7.46±12.95,P=0.001).4.The CD4+Tn percentage in peripheral blood of sepsis patients was negatively correlated with the APACHE ? score and SOFA score(correlation coefficient r=-0.433,P=0.004)(correlation coefficient r=-0.383,P=0.011);CD4+ Tem percentage was positively correlated with the APACHE ? score and the SOFA score(correlation coefficient r=0.308,P=0.045),(correlation coefficient r=0.335,P=0.028).CD4+ Tcm percentage was not correlated with the APACHE ? score and SOFA score;meanwhile,CD4+TEMRA percentage was also not correlated with the APACHE ? score and the SOFA score.Conclusion:1.The proportion of CD4+T lymphocytes in the peripheral blood of early sepsis patients is reduced,while that of CD8+T lymphocytes was relatively increased,and the CD4+T/CD8++T ratio was reduced.Moreover,the distribution of CD4+T lymphocytes with different immune subtypes is also changed,revealing that there is immunosuppression phenomenon in early sepsis patients.2.The combination of APACHE ? score and SOFA score with the changes in proportions of CD4+Tn and CD4+Tem in the peripheral blood of early sepsis patients can better predict the prognosis for sepsis patients. |
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