The Change Of TH17 In Peripheral Blood Of Patients With SIRS And The Effect On Inflammatory Response

ObjectiveInvestigate the percentage of Th17 in peripheral blood of patients with SIRS. Simultaneously, detection the expression of IL-17 and IL-6 in plasma of peripheral blood . Observe the change of Th17 in peripheral blood of patients with SIRS and the effect on inflammatory response.MethodsSelected seventy-five patients admitted in our intensive care unit from February 2010 to February 2011. All the patients were according to the reference standards of SIRS made in 1991-8(ACCP and SCCM).Take another thirty healthy volunteers that come from the examination center of our hospital as control. There was no difference in age and gender between cases and controls. Collected general information such as gender, age, primary disease, infection site etc. Detected body temperature, WBC, PMN, CRP, lactic acid, apache two score etc. There were twenty-five patients with sepsis, twenty patients with serious sepsis, eleven patients with septic shock and nineteen patients with serious multiple injury in the cases. Progressed routine screening of infection in the diagnosis patients with infection SIRS within twenty-four hours, included blood analysis, sputum culture, blood culture, x-ray etc. Implement the routine screening in patients with serious multiple injury within twenty-four hours and the fifth day, to observe secondary infection in patients. All patients follow-up visited for twenty-eight days or longer, recorded fatality.Peripheral blood was withdrawn from patients with SIRS within twenty-four hours after diagnosis and from healthy individuals. Two milliliter was taken at 4℃refrigerator ,stimulation and training within 2 hours.Flow cytometry (FCM)was used to determine the percentage of Th17.Simultaneously, plasma after centrifugation of peripheral blood stored at -80℃refrigerator for detection of cytokines IL-17 and IL-6 with ELISA. Implement the detection of Th17%,IL-17 and IL-6 levels in patients with serious multiple injury at the fifth day after diagnosis.ResultCompared with the control, the percentage of Th17 was significant higher and the level of IL-17 and IL-6 was also significant higher in patients with infection SIRS (all p<0.01). Simultaneously, the percentage of Th17,IL-17 and IL-6 was also higher in patients with serious multiple injury (p<0.05). The percentage of Th17 was positive correlated with the level of IL-17 and IL-6.Besides, the level of IL-17 was positive correlated with IL-6 too (all p<0.01).Further analysis showed that the percentage of Th17 was gradually increased in patients with sepsis, serious sepsis and septic shock. The percentage of Th17 was significant higher in patients with sepsis than that in patients with serious multiple injury (p<0.05). According to with or without secondary infection, patients with serious multiple injury were classified into two groups, group one with secondary infection and group two without secondary infection. There were significant elevation of Th17 in the former (p<0.05). In patients with SIRS the percentage of Th17 in survivor was significant higher than that of non-survivor (p<0.01).Conclusion1. The percentage of Th17 was significant higher in patients with SIRS. Th17 showed pro-inflammatory effect on the balance of inflammatory response.2. The percentage of Th17 declared positive correlation with IL-17 and IL-6. Th17 could effect the inflammatory response through a variety of ways. More higher of the percentage of Th17, more seriously reaction of inflammatory response. Mutual promotion between the three to increase the inflammatory response.3. The percentage of Th17 was gradually increased in patients with sepsis, serious sepsis and septic shock. Indicate that the inflammatory response in patients was gradually increased with the severity of sepsis. Showed higher proportion of Th17.4. The percentage of Th17 was significant higher in patients with sepsis than that in patients with serious multiple injury. The former declared evident disorder in inflammatory response.5. Patients with serious multiple injury were classified into two groups , group one with secondary infection and group two without secondary infection. There was significant elevation of Th17 in the former. More higher of the percentage of Th17, more seriously of the reaction of inflammatory response. Thus more likely to lead to secondary infection.6. According to prognosis, patients were divided into two groups , death group and survival group .the percentage of Th17 was higher in death group, indicated that Th17 can forecast the prognosis of patients with SIRS .