ABSTRACT
Objective To better understand the immune status in the rats after heatstroke. Methods Adult male SD rats were randomized into 3 groups: control group (n=20), classic heatstroke group (CHS, n=60) and exertional heatstroke group (EHS, n=60). Flow cytometry was employed to detect the percentage of CD4+CD25+Foxp3+ regulatory T cells (Tregs) in arterial blood and spleen as well as the apoptosis rate of Tregs in the spleen. To trace the dynamic changes on Treg cells, samples were collected at specific time points after heatstroke modeling (0, 6, 12, 24, 48, 72 hours post heatstroke). Results The proportion of Tregs in artery blood and spleen in CHS group increased gradually with a percentage lower than those in control group at first 24 h but higher than those in control group after 24 h. Interestingly, the proportion of Tregs in artery blood and spleen in EHS group was gradually reduced over time. The Tregs in the artery blood slightly higher than that in control group at 0 h followed by less than that in control group afterward; while Tregs in the spleen were higher than that in control group within 12 h, followed by less than that in control group after 24 h. The proportion of apoptotic Tregs in the spleen in CHS group was gradual decline over time, in the first 12 h they were higher than that in control group but lower than that in control group after 24 h. On the contrary, the proportion of apoptotic Tregs in the spleen in EHS group was gradually increased over time and was higher than that in control group at all time points. Conclusions The proportion of Tregs in peripheral blood and spleen in CHS group showed a rising trend during the early period. This is consistent with the trend in the spleen Tregs apoptosis rate, indicated that immunosuppression may have appeared in the early onset of CHS rats. However, the proportion of Tregs in peripheral blood and spleen in EHS group showed a trend of gradual reduction which is consistent with the spleen Tregs apoptosis rate. The opposite phenotype detected from CHS and EHS rats may due to the excessive inflammatory reaction promoted the apoptosis of Tregs in EHS rats.
ABSTRACT
Objective To explore the early changes in liver function and their prognostic value in patients with exertional heat stroke (EHS). Methods The clinical data of sixty-nine patients with EHS admitted to 10 military hospitals from 2005 to 2013 were retrospectively analyzed. Among them 57 survived and 12 died. The levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) in the first 10 days after the onset of heat stroke were detected. The receiver operating characteristic (ROC) curve was ploted to assess the prognostic value of the worst value of various parameters in patients with EHS. Results Serum aminotransferase reached the peak 3 to 4 days after onset of EHS, and then it began to decline, and serum bilirubin reached the peak 5 to 8 days after the onset, and then it began to decline slowly. Te relevant liver function indicators in death group were higher than those in survival group at corresponding days. Early onset of serum transaminases and bilirubin was found to have a high prognostic value, and the total area under the ROC curves of ALT for death judgment was 0.833 ± 0.064, with the best diagnostic point as 3016.5U/L. The total area under the ROC curves of AST for death judgment was 0.798 ± 0.073, and the best diagnostic point was 4745U/L. Te total area under the ROC curves of TBIL for death judgment was 0.810 ± 0.067, and the best diagnostic point was 123.9μJLmol/L. Te total area under the ROC curves of DBIL for death judgment was 0.836 ± 0.063, and the best diagnostic point was 87.42μxmol/L. Conclusions The changes in liver function at early stage of EHS onset show certain regularity. Te worst value of relevant liver function indicators has a high predictive value for the severity of the ailment and its prognosis, and the findings remind us to pay more atention to the risk of death when the value of liver function test reaches or higher than the best diagnostic level.