Changes of Thl/Th2 balance and serum cytokine levels in critically ill patients.

目的：分析几种躯体损伤对机体细胞免疫功能和血清细胞因子水平的影响。研究1：将胃肠道恶性肿瘤手术患者分为术后感染组和非感染组。在术前状态下，两组细胞内细胞因子染色检测到的产生干扰素-γ的CD4^+T细胞(Th L)的比例基本相同，但在术后第1天两组细胞比例均有所下降。术后7d，未感染组Th1细胞比例恢复至术前水平，感染组Th1细胞比例进一步增强。相比之下，两组产生IL-4的CD4^+T(Th2)细胞的比例在整个过程中几乎没有变化。单核细胞表面人类白细胞抗原-DR和CD16的表达变化与Th1细胞比例变化相似。两组…患者血清细胞因子水平变化无差异更多研究2：脓毒症患者被分成两组：第一组，接受富含omega-3脂肪酸的肠内饮食；第二组，接受常规肠内饮食。分别于喂养后第1、4、8天采集患者外周血样本。两组患者血清CRP、IL-6浓度均随时间推移逐渐降低，两组间无差异。两组CD4^+T细胞中Th2亚群的比例在整个病程过程中几乎没有变化。与第1天相比，第1组患者外周血中Th1细胞亚群比例在第8天显著升高，而第2组患者的比例无明显变化。单核细胞表面HLA-DR的表达在第1组也明显增加，而在第2组仅略有增加。结论：机体损伤后Th1细胞功能迅速受到抑制，这可能与感染的发生有关，而富含omega-3脂肪酸的肠内营养可能有利于激活危重患者的细胞免疫。较少

OBJECTIVE : To analysis on changes of cellular immune functions and serum cytokine levels for several bodily insults.RESEARCH 1 : Patients who underwent surgery for gastrointestinal malignancies were divided into two groups, with or without postoperative infection. In the preoperative state, the proportions of IFN-y -producing CD4^+ T (Th l) cells, which were detected by intracellular cytokine stainings using flow cytometry, were almost equal in the two groups, and the proportion decreased on POD 1 in both groups. On POD 7, the proportion of Thl cells recovered to the preoperative level in the non-infection group, while the suppression was further reinforced in the infection group. In contrast, the proportion of IL-4-producing CD4^+ T (Th2) cells showed little change through the course in both groups. Changes of HLA-DR and CD16 expression on monocytes were similar to those of the proportion of Thl cells. There were no differences on changes of serum cytokine levels between the two grou … More ps.RESEARCH 2 : Patients with sepsis were allocated into two groups : group 1, those who received an omega-3 fatty acids-enriched enteral diet ; group 2, those who received a conventional enteral diet. Peripheral blood samples were collected from each patient on days 1, 4, and 8 of feeding. Serum concentrations of CRP and IL-6 gradually decreased as time passed in both groups, and there was no difference in their concentrations between the two groups. The proportion of Th2 subset in CD4^+ T cells was almost unchanged through the course in both groups. In contrast, the proportion of Thl subset in group 1 patients significantly increased on day 8 comparing with that on day 1, while that in group 2 patients showed little. HLA-DR expression on monocytes was also significantly increased in group 1, whereas only a slight increase was found in group 2.CONCLUSIONS : These results suggest that bodily insults quickly induce the suppression of Thl cell functions, which may correlate with the occurrence of infection, and that omega-3 fatty acid-enriched enteral nutrition may be beneficial to activate cellular immunity for critically ill patients. Less