Correlation between early T lymphocyte subsets and natural killer cell levels and intestinal injury and prognosis in patients with sepsis / 中华急诊医学杂志

ABSTRACT

Objective:To explore the correlation between the levels of peripheral blood T lymphocyte subsets (CD3 +, CD4 +, CD8 +) and natural killer cells (NK cells) in the early stage of sepsis and intestinal injury and prognosis of patients, so as to provide the basis of immunotherapy for clinical treatment of sepsis. Methods:A prospective case-control study was conducted. Sixty-one patients with sepsis admitted to Department of Critical Care Unit (ICU) of Ningxia Medical University from September 2018 to May 2019 were selected as subjects (sepsis group). Seventeen patients with common postoperative non-sepsis were used as controls (non-sepsis group). Venous blood samples were collected from all subjects within 24 h of ICU admission, and the levels of T lymphocyte subsets and NK cells were measured. At the same time, 35 sepsis patients without chronic gastrointestinal tract and chronic renal insufficiency were selected from the sepsis group, and their serum levels of intestinal fatty acid binding protein (I-FABP) and D-lactic acid were measured. Age, sex, and underlying disease were recorded for all subjects. The acute physiology and chronic health evaluationⅡ(APACHEⅡscore) within 24 h of ICU in the sepsis group were evaluated, and the patients were followed up for 28 days. T lymphocyte subsets and NK cells, I-FABP, D-lactic acid levels were compared between the sepsis group and non-sepsis group. T lymphocyte subsets and NK cell levels were compared between the survival and death groups. Spearman correlation method was used to analyze the correlation between serum I-FABP and D-lactic acid in the early stage of sepsis and levels of CD3 +, CD4 +, CD8 + and NK cells, and multivariate logistic regression analysis was used to assess the risk factors of death in sepsis patients. Results:Compared with the non-sepsis group, serum I-FABP and D-lactic acid levels were increased in the sepsis group [I-FABP (μg/L) 18.36 (14.75, 28.34) vs 16.17 (12.12, 18.40), D- Lactic acid (mg/L) 18.70 (10.10, 40.60) vs 8.85 (7.10, 15.76), all P < 0.05]. Peripheral blood CD3 +, CD4 +, NK cells in the sepsis group were decreased [CD3 +(%) 54.30 (37.48 , 61.65) vs 60.75 (48.88, 69.95), CD4 +(%) 24.60 (17.65, 32.15) vs 31.90 (24.95, 37.10), NK cells (%) 18.20 (11.95, 31.10) vs 24.70 (19.30, 32.65), P<0.05], but there was no significant difference in peripheral blood CD8 + levels between the two groups ( P>0.05). There were no significant differences in CD3 +, CD4 +, CD8 + and NK cell levels between the survival group and death group (all P>0.05).Correlation analysis of T lymphocyte subsets, NK cells and intestinal injury markers ( n=35) showed that I-FABP was negatively correlated with CD3 + and CD8 + ( r=-0.478 and r=-0.415, respectively, both P<0.05), but not correlated with CD4 + and NK cells (both P>0.05). D-lactic acid was negatively correlated with CD3 + and CD4 + ( r=-0.344 and r=-0.423, respectively, P<0.05), and positively correlated with NK cells ( r=0.393, P<0.05), but there was no correlation between D-lactic acid and CD8 + (both P>0.05). Multivariate logistic regression analysis showed that only the APACHEⅡ score was an independent risk factor for 28-day mortality in patients with sepsis ( OR=1.222, 95% CI1.084-1.378, P<0.01), but the early CD3 +, CD4 +, CD8 +, NK cell levels were not associated with 28-day prognosis in patients with sepsis ( P>0.05). Conclusions:Immunosuppression can occur in the early stage of sepsis, which is related to intestinal damage, but is not associated with patient prognosis.