Reduction of Immunocompetent T Cells Followed by Prolonged Lymphopenia in Severe Sepsis in the Elderly
Reduction of Immunocompetent T Cells Followed by Prolonged Lymphopenia in Severe Sepsis in the Elderly
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DOI：
10.1097/ccm.0b013e318274645f
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发表时间：
2013-03-01
影响因子：
8.8
通讯作者：
Inokuchi, Sadaki
中科院分区：
文献类型：
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作者：
Inoue, Shigeaki;Suzuki-Utsunomiya, Kyoko;Inokuchi, Sadaki
目的：探讨老年严重脓毒症患者的免疫学变化。设计：为期一年的前瞻性观察研究。地点：一所大学附属医院的急诊科和重症监护室。患者：73例严重脓毒症患者和72名健康献血者。测量和主要结果：65岁及以上的老年脓毒症患者的3个月存活期明显低于成人。患者(18-岁)(60%vs.89%，p<；0.01)。我们发现，在败血症死亡的老年患者中，淋巴细胞减少的时间至少延长了21天，而成年和老年脓毒症幸存者的淋巴细胞数量都恢复了。为了解脓毒症患者的免疫状态，在确诊为严重脓毒症后48h内采集血样，并纯化外周血单核细胞进行流式细胞仪分析。与健康供者相比，成人和老年败血症患者的T细胞水平均显著降低(分别降低56%和57%)。有趣的是，在老年患者，尤其是死亡患者中，免疫活性CD28+T细胞亚群减少，而免疫抑制PD-1+T细胞和调节性T细胞(既是Foxp3+又是CD25+的CD4+T细胞)百分比增加，这可能反映了免疫抑制的最初迹象。结论：免疫活性T细胞减少继而淋巴细胞减少可能与老年脓毒症患者预后不良有关。(Crit Care Med 2013；41：810-819)
Objective: To investigate the immunological changes caused by severe sepsis in elderly patients.Design: One-year, prospective observational study.Setting: Emergency department and intensive care unit of a single university hospital.Patients: Seventy-three patients with severe sepsis and 72 healthy donors.MeasurementsandMainResults:In elderly septic patients (aged 65yr and over), 3-month survival was significantly reduced compared with that for adult. patients (18-64 yr) (60% vs. 89%, p < 0.01). We found that lymphopenia was prolonged for at least 21 days in elderly nonsurvivors of sepsis, while the number of lymphocytes recovered in both adult and elderly survivors of sepsis. In order to examine the immunological status of septic patients, blood samples were collected within 48 hrs of diagnosis of severe sepsis, and peripheral blood mononuclear cells were purified for flow cytometric analysis. T cell levels were significantly reduced in both adult and elderly septic patients, compared with those in healthy donors (56% and 57% reduction, respectively). Interestingly, the immunocompetent CD28+ subset of CD4+ T cells decreased, whereas the immunosuppressive PD-1+ T cells and the percentage of regulatory T cells (CD4+ T cells that are both Foxp3+ and CD25+) increased in elderly patients, especially nonsurvivors, presumably reflecting the initial signs of immunosuppression.Conclusion: Reduction of immunocompetent T cells followed by prolonged lymphopenia may be associated with poor prognosis in elderly septic patients. (Crit Care Med 2013; 41:810-819)