Study On Inflammatory Cytokines And Regulatory T Cell Imbalance In Peripheral Blood Of Patients With Sepsis

Objective:To study the dynamic changes of T lymphocyte subsets,peripheral blood Treg cells,proinflammatory cytokines IL-6 and TNF-a,inhibiting inflammatory factors IL-10 and TGF-P in patients with sepsis and septic shock,enrich the understanding of immune disorders in patients with sepsis.Method:From February 2017 to February 2018,44 patients(15 patients in Septic shock,11 patients in sepsis,18 patients without sepsis)were collected from emergency ICU of the First Affiliated Hospital of Dalian Medical University.On the day of the diagnosis of sepsis or sepsis shock,peripheral blood lymphocyte subsets were analyzed to evaluate the immune status of patients with sepsis,and 18 non-sepsis patients were included in the control group.The levels of IL-6,IL-10,TGF-?,TNF-a in peripheral blood serum of sepsis patients were detected by ELASA on day 1,3,7 after sepsis was confirmed.At the same time,flow cytometry was used to detect the expression of Treg cells in peripheral blood of patients with sepsis and sepsis shock on the 3rd and 7th day after the diagnosis of sepsis.Evaluate the APACHE ? scores of patients with sepsis on admission day,sofa score on the day of sepsis or septic shock,dayl,day 3,day 7.To study the correlation between APACHE ? score and inflammatory factor expression and Treg cell expression,to compare the change trend of inflammatory and anti inflammatory factors in septic shock group,septic group and non-septic group.To explore the relationship between the change trend of proinflammatory factor?anti-inflammatory factor and the prognosis of patients.Results:1.Classification by severity:In the same day of diagnosis of septic shock andsepsis,lymphocyte subsets analysis showed that the proportion of CD4 + T cells(Th)in the sepsis group was lower than the non-sepsis group,statistically significant.But there was no statistical difference among the three groups in lymphocyte ratio?CD8 +T cells ratio and Th/Ts.On the first day of diagnosis,the proinflammatory mediators interleukin-6 and TNF-a showed the highest in the septic shock group,followed by the sepsis group and the lowest in the non-sepsis group.And for IL-10,we can also find the phenomenon that septic shock group is significantly larger than that of non-sepsis group.The differences between these groups are consistent with the APACHE II and SOFA scores,which indicate the severity of the disease.The ratio of CD4 + T cells to nucleated cells decreased with the severity of the disease,but the ratio of Treg to CD4 +T cells was increased,the difference was statistically significant(p<0.05).2.Grouped by survival and death:The IL-6 in death group increased gradually on the 1st day?3rd day and the 7th day,and was significantly higher than the survival group on the 7th day,the difference was statistically significant.Similarly,TNF-a in the death group showed a trend of increasing gradually,and was significantly higher than that in the survival group on the 7th day(the difference was statistically significant).In addition,TGF-? increased gradually in the death group,which was significantly higher on the 7th day than on the first day.The ratio of CD4+T cells in the dead group was lower than that in the survival group,while the proportion of Treg in the dead group was higher than that in the survival group.However,a binary Logistic regression analysis of serous prognosis for meaningful indicators found that only APACHE II could be used as a risk factor for the prognosis of sepsis.Because of the complicated condition of patients with sepsis,the inflammatory factors and immune state are constantly changing in the course of treatment,and the inflammatory reaction of the patients shows diversity and complexity,and the inflammatory factors have the characteristics of multi-efficiency,network,overlap,etc.This study has not found that other significant indicators can be used as an independent risk factor for the prognosis of sepsis.Conclusion:1.In the early stage of sepsis,the immune function was decreased,but the immune function was not significantly decreased.2.In the early stage of sepsis,a large number of inflammatory factors,such as IL-6.TNF-?,are released,but not only the pro-inflammatory mediators,but also the anti-inflammatory mediators such as IL-10?TGF-p.This indicates that the anti-inflammatory response is out of balance in the early stage of sepsis.There was a significant positive correlation between pro-inflammatory mediators and APACHE II scores and SOFA scores of the severity of the reaction.Moreover,there is a positive correlation between pro-inflammatory mediators,and the increasing inflammation may lead to worse clinical prognosis.3.During the development of sepsis,the proportion of CD4+T cells decreased,while the ratio of regulatory T cells to CD4+T cells increased.The more serious the disease is,the more obvious the change is,and the change may associated with poor prognosis.The more severe the patients are,the more obvious the immunosuppression is,which may lead to worse prognosis.