Klinik für Anästhesiologie and Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, Germany.
Intensive Care Med. 2013 Oct;39(10):1743-51. doi: 10.1007/s00134-013-3036-3. Epub 2013 Aug 16.
Cell therapy may become an option for lung injury treatment. However, no data are available on the alveolar presence and time course of CD4+ CD25 + Foxp3 + T-regulatory lymphocyte cells (Tregs) in acute respiratory distress syndrome (ARDS). Accordingly, we (1) measured the ratio of CD4 + CD25 + Foxp3 + Tregs to all (CD4+) lymphocytes in the bronchoalveolar lavage (BAL) of ARDS patients and of control subjects without lung disease and (2) assessed their impact on 30-day mortality.
In a prospective study, the ratios of CD4 + CD25 + Foxp3 + T-regulatory cells to all CD4+ cells were measured (FACS) within 24 h of the patients' ICU referral in the BAL and in the blood of 47 patients with ARDS (32 males, 15 females; mean age 44 years ±13) as well as in 8 controls undergoing elective abdominal surgery (5 men, 3 women; mean age 49 years ±4). BAL concentrations of several cytokines were also measured in ARDS patients.
Tregs were detected in the BAL of control subjects and ARDS patients. However, the mean ratio of Tregs to all CD4+ lymphocytes was threefold greater in ARDS non-survivors (16.5%; p = 0.025) and almost twofold greater in ARDS survivors (9.0%; p = 0.015) compared to controls (5.9%). Multivariate Cox regression analysis revealed the ratio of CD4 + CD25 + Foxp3 + T-regulatory lymphocytes to all CD4+ lymphocytes in the BAL to be an important and independent prognostic factor for 30-day survival (HR 6.5; 95% CI, 1.7-25; p = 0.006).
An increased T-regulatory cell ratio in the admission BAL of patients with ARDS is an important and independent risk factor for 30-day mortality.
细胞疗法可能成为肺损伤治疗的一种选择。然而，关于急性呼吸窘迫综合征（ARDS）患者肺泡中 CD4+CD25+Foxp3+T 调节性淋巴细胞（Tregs）的存在及其时间过程，尚无数据。因此，我们（1）测量了 ARDS 患者和无肺部疾病的对照者支气管肺泡灌洗液（BAL）中 CD4+CD25+Foxp3+Tregs 与所有（CD4+）淋巴细胞的比值，（2）评估了它们对 30 天死亡率的影响。
在一项前瞻性研究中，在 ARDS 患者 ICU 转介后 24 小时内，通过流式细胞术（FACS）测量了 BAL 和血液中 CD4+CD25+Foxp3+T 调节细胞与所有 CD4+细胞的比值，共纳入 47 名 ARDS 患者（32 名男性，15 名女性；平均年龄 44 岁±13 岁）和 8 名接受择期腹部手术的对照者（5 名男性，3 名女性；平均年龄 49 岁±4 岁）。还测量了 ARDS 患者 BAL 中的几种细胞因子浓度。
在对照者和 ARDS 患者的 BAL 中均检测到 Tregs。然而，ARDS 非幸存者（16.5%；p=0.025）和 ARDS 幸存者（9.0%；p=0.015）的 Tregs 与所有 CD4+淋巴细胞的平均比值是对照组的三倍和两倍。多变量 Cox 回归分析显示，BAL 中 CD4+CD25+Foxp3+T 调节性淋巴细胞与所有 CD4+淋巴细胞的比值是 30 天生存的重要且独立的预后因素（HR 6.5；95%CI，1.7-25；p=0.006）。
ARDS 患者入院时 BAL 中 T 调节细胞比例增加是 30 天死亡率的一个重要且独立的危险因素。
