Change And Its Clinical Significance Of Myeloid-derived Suppressor Cells In Peripheral Blood Of Severe Multiple Trauma Patients

Objective: Prospective analysis the relationships between the change of myeloid-derived suppressor cells in peripheral blood of multiple trauma patients during acute phase in Shanghai First People's Hospital and trauma severity,immune status as well as the infection rate,to better evaluate the immune status for those patients,and to provide more significant biomarkers for precise immunotherapy.Methods: A total of 30 patients with severe multiple trauma at emergency ICU in Shanghai general hospital(2016.10-2017.02)were recruited in this study,and the MDSCs and T-lymphocyte in peripheral blood were measured at the 1d,3d and 7d after trauma by flow cytometry,which was further compared to the results of 10 healthy patients.Meanwhile,all patients were divided into two groups according to the infection status,and the difference in MDSCs between two groups were analyzed.Results:1.Peripheral G-MDSCs began to increase at the first day after trauma in patients with severe multiple trauma,which was significantly different to the health controls(p<0.05);elevating continued on the 3d after trauma,which was significantly different to the results of at 1d after and controls(p<0.05);peripheral G-MDSCs was lowered on the 7d,but with no statsitical significance(p>0.05);Spearman correlation analysis indicated positive correlations between G-MDSCs and ISS scoring the 1d or the 3d after trauma(r1=0.36,r3 =0.465,p<0.05);no statistical significance was observed in peripheral M-MDSCs in patients with severe multiple trauma the 1d after trauma(p>0.05),while statistical significance was found on the 3d comparing to the results of healthy controls(p<0.05).With severe multiple trauma,no significant statistical difference was obtained in G-MDSCs between infection group and non-infection group(p>0.05).2.Peripheral CD4+ showed a decreasing tendency after trauma in studied patients,and significant differences were observed between the 1d after trauma and the results from healthy controls,the 3d or the 7d after trauma(p<0.05);no statistical significance was observed in peripheral CD8+ among the results from the 1d,the 3d and the 7d after multiple trauma in patients as well as healthy controls;Spearman correlation analysis indicated positive correlations between CD4/CD8 and ISS scoring the 1d after trauma(r1=-0.446,p<0.05);the proportion of regulatory T cells showed a gradually elevating tendency after trauma among studied patients,and statistical significances were found between the 3d after trauma and healthy controls as well as the 1d,the 7d after trauma(p<0.05);the proportion of peripheral NK cells was gradually elevated among the patients with multiple trauma,and significant statistical difference was observed between results the 7d and the 1d after trauma(p<0.05).3.The levels of IL-6,PCT and CRP in the infection group were higher than in the infection group,significant statistically significant at the 1d,the 3d and the 7d(p < 0.05).4.The G-MDSCs has positive correlation with PCT at the 7d the patients with multiple trauma.Conslusions: Patients with severe multiple trauma mighty suffer from immune dysfunction in early stage,especially the cellular immune function mediated by T-lymphocytes were significantly inhibited.The proportion of MDSCs was significantly elevated in early stage,such as G-MDSCs,in particular.It had positive correlation with the trauma severity in patients,which maybe applied to predict the prognosis in patients.