| Objective To analyze the differential expression of soluble programmed death-1(sPD-1)in patients with sepsis,and to explore the role of soluble PD-1 in the immune suppression associated with sepsis.Methods Prospective observational research methods were used to select patients admitted to the Department of Intensive Medicine(ICU)of??Medical University General Hospital from June 2018 to December 2018.There were 31 patients in the toxic shock group,and 15 patients who had not undergone sepsis after general surgery in the ICU of??Medical University General Hospital during the same period were selected as the general surgery control group,and 15 healthy volunteers were recruited as the healthy control group.When healthy volunteers were enrolled,peripheral blood samples were taken.Patients in the general surgery control group,sepsis group,and septic shock group were placed in ICU within 24 hours to collect peripheral blood samples,and sPD-was detected by enzyme-linked immunosorbent assay(ELISA).Level 1,immunoglobulin turbidimetric determination of immunoglobulin IgG,IgA,IgM,complement C3,C4,flow cytometry lymphocyte immunoassay,except for the healthy control group,the remaining three groups measured arterial blood gas analysis and entered lactate value(LAC)And other laboratory indicators.Record the ICU 24h acute physiology and chronic health status?(APACHE?)score andsequential organ failure(SOFA)score.On the third and seventh days of admission to the ICU,the peripheral blood samples of patients in the sepsis and septic shock groups who were still receiving treatment in the ICU were taken again,and the above indicators were measured.Patients with sepsis and septic shock were followed up for 28 days of survival,and were divided into survival group(43 cases)and death group(17 cases)according to survival.Result1.Comparison of blood sPD-1,lymphocyte subsets and immunoglobulin levels among the four groups(1)Comparison of sPD-1 in different phases of each group: healthy control group,general surgery control group,sepsis group,and septic shock group into sPD-1 on the first day of ICU [pg / ml,M(P25,P75)] In order:200.51(162.14,241.26),191.56(151.26,232.66),261.90(191.96,421.99),512.64(216.85,1039.41).Compared with the healthy control group,there was no significant change in the sPD-1 of the general surgery control group(P>0.05).SPD-1 in the sepsis group and septic shock group was significantly higher than that in the healthy control group and general surgery control group(P <0.05),and compared with the sepsis group,the sPD-1 in the septic shock group was significantly increased(P <0.05).The sPD-1 [pg / ml,M(P25,P75)]in the sepsis group and septic shock group on the third day of ICU were:246.41(219.82,1,3.86),368.31(228.79,819.92).Compared with the general surgery control group,sPD1 in the septic shock group was significantly higher(P <0.05),and there was no significant increase in the septic group,and there was no significant difference between the septic group and the septic shock group.The sPD-1 [pg / ml,M(P25,P75)] in the sepsis group and septic shockgroup on the seventh day of ICU were: 286.52(221.62,311.45),543.03(267.27,1023.69)in order.Compared with the general surgery control group,sPD-1 in the septic shock group was still significantly increased(P <0.05),no significant increase in the septic group,and no significant difference between the septic group and the septic shock group(All P> 0.05).(2)Comparison of lymphocyte count,lymphocyte percentage,and lymphocyte subsets in different phases of each group: Compared with the healthy control group on the first day after entering the ICU,there was no significant change in various indicators of the general surgery control group(all P> 0.05).The lymphocyte count,lymphocyte percentage,and total T lymphocyte percentage in the sepsis and septic shock groups were significantly lower than those in the healthy control group and the general surgery control group(both P <0.05).There was no difference in CD8 + T cell%,CD4 + T cell% and helper / suppressor T cell ratio between the four groups(all P> 0.05).On the third day after entering the ICU,compared with the normal surgery control group,the percentage of lymphocytes in the sepsis group and the septic shock group was still significantly lower(both P <0.05),but there was no significant change in the lymphocyte count in the sepsis group(P> 0.05),the lymphocyte count in the septic shock group was still lower than that in the normal surgery control group(P <0.05).On the seventh day of ICU admission,the lymphocyte count,the percentage of lymphocytes,the percentage of total T lymphocytes,the percentage of CD8 + T cells,the percentage of CD4 + T cells,and the ratio of helper / suppressed T cells compared with the control group,There was no statistical difference in all indexes(all P> 0.05).The total T lymphocyte% and CD8 + T lymphocyte% ofthe septic shock group were still lower than that of the ordinary surgical control(all P <0.05).There was no difference in the general surgery control group(all P> 0.05).(3)Comparison of the ratio of immunoglobulin,complement,NK cell ratio and total B lymphocyte ratio in different phases of each group:Compared with the healthy control group on the first day after entering the ICU,there was no significant difference in each index of the general surgery control group(P> 0.05).Compared with the healthy control group and the general surgery control group,immunoglobulin IgG and IgM were reduced in the septic shock group and the sepsis group;complement C3 was reduced only in the septic shock group(both P <0.05).Moreover,only complement C3 in the septic shock group was significantly lower than that in the sepsis group(P<0.05),and there was no significant difference between the other indexes(both P> 0.05).There was no significant difference in the percentages of immunoglobulin IgA,complement C4,NK cells and percentage of total B lymphocytes between the four groups(all P> 0.05).On the seventh day after entering the ICU,no significant differences were seen in the immunoglobulin IgG,IgM,IgA,complement C3,C4,NK cells(%),and total B lymphocytes(%)in the sepsis group compared with the general surgery control group(All P>0.05),only immunoglobulin IgA increased in the septic shock group(P <0.05),and the other indicators were no different from the ordinary surgery control group(all P> 0.05).There were no significant differences between the sepsis group and the septic shock group(all P> 0.05).2.Comparison of different indexes in different phases of the septic shock group:(1)Comparison of sPD-1 in different phases of each group: healthy control group,general surgery control group,sepsis group,and septic shock group into sPD-1 on the first day of ICU [pg/ml,M(P25,P75)]: 200.51(162.14,241.26),191.56(151.26,232.66),261.90(191.96,421.99),512.64(216.85,1039.41).Compared with the healthy control group,there was no significant change in sPD-1 in the normal operation control group(P>0.05).SPD-1 in the sepsis group and septic shock group was significantly higher than that in the healthy control group and general surgery control group(P<0.05),and compared with the sepsis group,the sPD-1 in the septic shock group was significantly increased(P<0.05).The sPD-1 [pg/ml,M(P25,P75)]in the sepsis group and septic shock group on the third day of ICU were:246.41(219.82,1,3.86),368.31(228.79,819.92).Compared with the normal surgery control group,sPD1 in the septic shock group was significantly higher(P<0.05),but there was no significant increase in the septic group;septic shock was significantly higher than the septic group(P<0.05).The sPD-1[pg/ml,M(P25,P75)] in the sepsis group and septic shock group on the seventh day of ICU were: 286.52(221.62,311.45),543.03(267.27,1023.69)in order.Compared with the normal surgery control group,sPD-1 in the septic shock group was still significantly increased(P<0.05),and there was no significant increase in the septic group;septic shock was significantly higher than the septic group(P<0.05).(2)Comparison of immunoglobulin,complement,NK cell ratio and total B lymphocyte ratio at different phases in the septic shock group:immunoglobulin IgG,IgA,complement C3 on the seventh day of ICU admission into the septic shock group Compared with the first day afterentering the ICU(all P <0.05);the proportion of immunoglobulin IgM,complement C4,NK cells,and the proportion of total B lymphocytes,compared with the first day of entering the ICU,no significant differences were found(all P > 0.05).3.Comparison of sPD-1,cellular immunity,and humoral immunity in survival and death groups(1)There were no significant differences in sPD-1,lymphocyte count,lymphocyte percentage,and lymphocyte subsets on the first day of ICU in the death group and the survival group(both P> 0.05).(2)Changes in various indicators in the survival group and the death group: sPD-1 [pg / ml,M(P25,P75)] in the survival group into the ICU for one,three,and seven days: 316.42(216.85,859.21),344.35(236.91,781.60),278.09(221.57,579.99).The sPD-1 level in the survival group did not change significantly with the length of stay(P> 0.05).The lymphocyte count and percentage of lymphocytes,immunoglobulin IgG,IgA,IgM,and complement C3 in the survival group on the seventh day of ICU were significantly higher than those on the first day(all P <0.05).The death group entered sPD-1 [pg /ml,M(P25,P75)] at ICU one,three,and seven days: 225.57(184.06,532.48),302.15(204.92,370.71),652.16(424.69,1801.39),death group sPD-1gradually increased with the length of stay(all P <0.05).There was no significant difference in the remaining indicators within the death group(all P> 0.05).4.Correlation analysis of various indicatorsIn patients with sepsis and septic shock,sPD-1 was positively correlated with SOFA score(r value: 0.30,P <0.01).On the seventh day of septic shockgroup,sPD-1 was negatively correlated with the ratio of helper / suppressor T cells in the analysis of lymphocyte subsets(r value:-0.66,P <0.05).There was no significant correlation between sPD-1 and lymphocyte count,percentage of lymphocytes,% of total T lymphocytes,% of CD4 + cells,% of CD8 + cells(all P> 0.05).5.Prognostic analysis: Logistic regression analysis showed that the APACHE II score(OR = 1.17,P = 0.01)on the first day of ICU admission was an independent risk factor for death in patients with sepsis and septic shock.The ROC curve analysis of sPD-1 on the 28-day prognosis of patients with sepsis and septic shock suggested that sPD-1 on the seventh day of ICU has a predictive value on the 28-day prognosis of the patients(P <0.05).Conclusion 1.The expression level of sPD-1 in the peripheral blood of patients with sepsis is related to the severity of the disease.The sPD-1 on the seventh day of ICU can effectively predict the 28-day prognosis of patients with sepsis and septic shock.2.sPD-1 is related to the imbalance of T lymphocyte helper/suppressor ratio. |
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