Profound and persistent decrease of circulating dendritic cells is associated with ICU-acquired infection in patients with septic shock
Profound and persistent decrease of circulating dendritic cells is associated with ICU-acquired infection in patients with septic shock
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DOI：
10.1007/s00134-011-2306-1
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发表时间：
2011-09-01
影响因子：
38.9
通讯作者：
Chiche, J. D.
中科院分区：
文献类型：
--
作者：
Grimaldi, D.;Louis, S.;Chiche, J. D.
脓毒症休克诱导树突状细胞（DC）减少，这可能有助于脓毒症诱导的免疫抑制。我们分析了感染性休克患者循环树突状细胞的时间进程及其与重症监护病房（ICU）获得性感染易感性的关系。我们纳入了感染性休克（n = 43），非感染性休克（n = 29），和败血症无器官功能障碍（n = 16）的成人患者。健康对照组（n = 16）作为参照。在休克当天（第1天）、3天和7天后抽取血液样本。通过流式细胞术计数髓样（mDC）和浆细胞样（pDC）DC。在第1天，与健康对照相比，脓毒性休克患者的中位mDC和pDC计数显著降低（分别为835 mDC和178 pDC/ml对19，342 mDC和6，169 pDC/ml; P < 0.0001），但也低于非脓毒性休克和脓毒症患者（P < 0.0001）。与健康对照组相比，感染性休克组中mDC和pDCS中HLA-DR表达均降低。感染性休克患者DC耗竭持续至少7天。其中，10/43例患者在中位9 [7.5-11]天后发生ICU获得性感染。在第7天，没有继发感染的患者的mDC计数增加，而那些随后发生ICU获得性感染的患者的mDC计数仍然很低。低mDC计数的持续与ICU获得性感染的发展相关，表明DC耗竭是脓毒症诱导的免疫抑制的功能特征。
Septic shock induces a decrease in dendritic cells (DCs) that may contribute to sepsis-induced immunosuppression. We analyzed the time course of circulating DCs in patients with septic shock and its relation to susceptibility to intensive care unit (ICU)-acquired infections.We enrolled adult patients with septic shock (n = 43), non-septic shock (n = 29), and with sepsis without organ dysfunction (n = 16). Healthy controls (n = 16) served as reference. Blood samples were drawn on the day of shock (day 1), then after 3 and 7 days. Myeloid (mDC) and plasmacytoid (pDC) DCs were counted by flow cytometry. Cell surface HLA-DR expression was analyzed in both DC subsets.At day 1, median mDC and pDC counts were dramatically lower in septic shock patients as compared to healthy controls (respectively, 835 mDCs and 178 pDCs/ml vs. 19,342 mDCs and 6,169 pDCs/ml; P < 0.0001) but also to non-septic shock and sepsis patients (P < 0.0001). HLA-DR expression was decreased in both mDCs and pDCS within the septic shock group as compared to healthy controls. DC depletion was sustained for at least 7 days in septic shock patients. Among them, 10/43 developed ICU-acquired infections after a median of 9 [7.5-11] days. At day 7, mDC counts increased in patients devoid of secondary infections, whereas they remained low in those who subsequently developed ICU-acquired infections.Septic shock is associated with profound and sustained depletion of circulating DCs. The persistence of low mDC counts is associated with the development of ICU-acquired infections, suggesting that DC depletion is a functional feature of sepsis-induced immunosuppression.