T regulatory cells activation and distribution are modified in critically ill patients with acute respiratory distress syndrome: A prospective single-centre observational study
T regulatory cells activation and distribution are modified in critically ill patients with acute respiratory distress syndrome: A prospective single-centre observational study
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DOI：
10.1016/j.accpm.2019.07.014
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发表时间：
2020-02-01
影响因子：
5.5
通讯作者：
Monsel, Antoine
中科院分区：
文献类型：
--
作者：
Halter, Sebastien;Aimade, Lucrece;Monsel, Antoine
背景：急性呼吸窘迫综合征（ARDS）是一种常见且致命的炎症性疾病。调节性 T 细胞 (Treg) 是有益还是有害仍存在争议，且缺乏纵向研究。 Tregs 激活标记的表型分析报道很少。我们的目的是评估 ARDS 患者血液和支气管肺泡 Treg 表型的定量和功能变化。方法：我们在法国重症监护病房进行了一项单中心观察性研究。该研究招募了 60 名 ARDS 患者和 45 名非 ARDS 患者。 18 岁以下或患有免疫抑制（天然或获得性）的患者被排除在外。通过流式细胞术评估 Tregs 表型，并通过多重分析检测 ARDS 发病后 3 周内收集的血液和支气管肺泡样本中的细胞因子。结果：ARDS 患者的血液 Tregs/CD4+ 百分比（中位数 %，四分位数 25-75%）高于非 ARDS 患者：12.1% [9.0-16.0] 对比 9.9% [8.1-12.6]，P=0.01。 ARDS 患者的肺泡 Tregs/CD4+ 百分比低于非 ARDS 患者：10.4% [6.3-16.6] vs 16.2% [12.4-21.1]，P = 0.03。与非 ARDS 患者相比，ARDS 患者血液中的 Tregs 激活减少，肺泡中的 Tregs 激活增加。 ROC 分析显示，ARDS 第一周内采集的血液中 Tregs/CD4+ 百分比的阈值为 10.4%，用于区分幸存者和非幸存者（敏感性：75%；特异性 76%；曲线下面积 [95% 置信区间 0.72 [0.5-0.9]）。结论：在 ARDS 患者中观察到 Treg 表型的定量和功能改变。通过治疗干预重新平衡 Tregs 表型是否有益值得进一步研究。 (C) 2019 法国麻醉与复活协会 (Sfar)。由 Elsevier Masson SAS 出版。版权所有。
Backgrounds: Acute respiratory distress syndrome (ARDS) is a common and fatal inflammatory condition. Whether T regulatory cells (Tregs) are beneficial or detrimental remains controversial, and longitudinal studies are lacking. Phenotyping of Tregs activation markers has been poorly reported. We aimed to evaluate quantitative and functional alterations in blood and bronchoalveolar Treg phenotype of ARDS patients.Methods: We performed a single-centre observational study in a French intensive care unit. The study enrolled 60 ARDS and 45 non-ARDS patients. Patients under 18 years old or with immunosuppression (native or acquired) were excluded. Tregs phenotypes were assessed by flow cytometry, while cytokines were measured by multiplex-based assays in blood and bronchoalveolar samples collected over 3 weeks after the onset of ARDS.Results: Blood Tregs/CD4+ percentage (median %, 25-75% interquartile) was higher in ARDS patients than in non-ARDS patients: 12.1% [9.0-16.0] versus 9.9% [8.1-12.6], P= 0.01. Alveolar Tregs/CD4+ percentage was lower in ARDS patients than in non-ARDS patients: 10.4% [6.3-16.6] versus 16.2% [12.4-21.1], P = 0.03. In ARDS patients, Tregs activation was reduced in the blood and increased in the alveolus, compared to non-ARDS patients. ROC analysis revealed a threshold of 10.4% for the Tregs/CD4+ percentage in the blood collected within the first week of ARDS to discriminate between survivors and non-survivors (sensitivity: 75%; specificity 76%; area under the curve [95% confidence interval 0.72 [0.5-0.9]).Conclusions: Quantitative and functional alterations in Treg phenotype were observed in patients with ARDS. Whether rebalancing Tregs phenotype with therapeutic interventions would be beneficial deserves further investigations. (C) 2019 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.