重症急性胰腺炎免疫功能紊乱与调控

发布时间：2018-01-15 09:35

本文关键词：重症急性胰腺炎免疫功能紊乱与调控　出处：《天津医科大学》2005年博士论文　论文类型：学位论文

【摘要】：目的:动态观察并探讨急性胰腺炎患者免疫功能的变化。方法:应用流式细胞仪动态监测24例轻型急性胰腺炎(MAP)患者和22例重症急性胰腺炎(SAP)患者发病第1、3、7天外周血T淋巴细胞CD4~+、CD8~+两个亚群各自的比例变化与凋亡情况;同时监测单核细胞表面人类白细胞抗原DR(HLA-DR)的表达情况以判断其抗原呈递功能。最后集中行血清细胞因子TNR-α、IL-6、IL-10水平测定。结果:与MAP组及健康对照组相比,SAP组患者CD4~+T细胞明显减少,CD4~+/CD8~+比值明显下降,出现细胞免疫功能缺陷;此外,CD4~+T细胞的凋亡率明显增加,与上述二者的变化呈显著负相关。SAP组单核细胞HLA-DR的表达在整个观察期内明显低于其他两组,提示单核细胞抗原呈递功能受损,而MAP组HLA-DR的下降很快得以恢复。SAP组患者血清促炎细胞因子IL-6和抗炎细胞因子IL-10水平均显著高于MAP组与健康对照组,IL-6/IL-10比值自第3天起持续下降,显著低于其他两组,呈现出明显的抗炎反应优势。结论:SAP病程中,促炎/抗炎反应机制严重失衡,随着病程发展,逐渐呈现出的过度抗炎反应优势导致患者出现严重而持久的免疫功能抑制,表现为T淋巴细胞亚群比例失调、单核细胞抗原呈递功能受损,是SAP病程中后期容易发生严重感染的重要原因,值得引起充分关注。
[Abstract]:Objective: to investigate the changes of immune function in patients with acute pancreatitis. Methods: 24 patients with mild acute pancreatitis and 22 patients with severe acute pancreatitis were dynamically monitored by flow cytometry (FCM). SAP). 3The ratio and apoptosis of CD4 ~ + CD8 ~ (2) subsets in peripheral blood T lymphocytes were observed on the 7th day. At the same time, the expression of HLA-DRN on the surface of monocytes was monitored to determine the antigen-presenting function. Finally, the serum cytokine TNR- 伪 IL-6 was collected. Results: compared with the MAP group and the healthy control group, the CD4T cells in the MAP group were significantly decreased and the ratio of CD4 ~ / / CD8 ~ ~ was significantly decreased. The cellular immune function was defective; In addition, the apoptotic rate of CD4T cells was significantly increased, which was negatively correlated with the above two changes. The expression of HLA-DR in monocytes in SAP group was significantly lower than that in other two groups during the whole observation period. These results suggest that monocyte antigen presentation is impaired. The levels of serum proinflammatory cytokines (IL-6) and anti-inflammatory cytokines (IL-10) in MAP group were significantly higher than those in MAP group and healthy control group. The ratio of IL-6/IL-10 decreased continuously from the 3rd day, which was significantly lower than that of the other two groups, showing obvious superiority of anti-inflammatory response. Conclusion the mechanism of proinflammatory / anti-inflammatory response is seriously out of balance in the course of IL-6/IL-10. With the development of the course of disease, the advantages of excessive anti-inflammatory response gradually lead to severe and persistent immunosuppression, which is characterized by the imbalance of T lymphocyte subsets and the impairment of monocyte antigen presentation function. It is an important cause of severe infection in the middle and late stage of SAP, and deserves full attention.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2005
【分类号】：R657.5;R392

【共引文献】