Department of Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601 Anhui Province People's Republic of China.
Hematology department, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 Anhui Province People's Republic of China.
World J Emerg Surg. 2017 Feb 2;12:7. doi: 10.1186/s13017-017-0116-7. eCollection 2017.
It has been suggested that severity of the immune response induced by immune cells is associated with morbidity and mortality from acute pancreatitis. The authors investigated and evaluated the relationship between distinct peripheral lymphocyte subsets at admission and clinical outcome prior to hospital discharge so as to find a predictor to the prognosis of acute pancreatitis in lymphocyte profile.
Lymphocyte subsets in admission peripheral venous blood were tested through flow cytometry on 48 patients with acute pancreatitis. Clinical data was recorded as well. The primary observational outcomes were multiple organ failure (MOF) and infection.
There was a significant difference in natural killer cells between two subgroups sorted by the presence or absence of infection (25.5 ± 4.47 [95% CI 14.4, 36.6] 14.8 ± 7.62 [95% CI 12.5,1 7.1] = 0.021). Patients who developed MOF had lower CD4 + CD25 + CD127 (4.49 ± 1.5 (MOF) [95% CI 3.83, 5.16] 6.57 ± 2.65 (non-MOF) [95% CI 5.5, 7.64] = 0.002) and higher CD127low/high cell counts (1.35 ± 0.66 [95% CI 1.06, 1.65] 0.97 ± 0.44 [95% CI 0.79, 1.15] = 0.02). MOF patients were significantly older (55 ± 14.58 [95% CI 48.49,61.42] 46 ± 15.59 [95% CI 39.39,51.99] = 0.04), and had higher Acute Physiology and Chronic Health Evaluation IIscores (7 ± 3.66 [95% CI 5.5,7.64] 4 ± 2.89 [95% CI 2.45,4.78] = 0.001) and C reactive protein (100.53 ± 94.38 [95% CI 58.69,142.48] 50.8 ± 59.2 [95% CI 26.88,74.71] = 0.04). In a multivariate regression model, only CD4 + CD25 + CD127 cell was a significant predictor of non-MOF. For the detection of non-MOF, CD4 + CD25 + CD127 cell generated a receiver operating characteristic (ROC) curve with an area under the curve of 0.74.
CD4 + CD25 + CD127 cell at early phase of acute pancreatitis yields good specificity in detecting non-MOF at a suggested cutoff value 6.41%. Patients with fewer natural killer cells may be at risk in developing secondary infection.
有研究表明，免疫细胞诱导的免疫反应的严重程度与急性胰腺炎的发病率和死亡率有关。作者研究并评估了入院时不同外周血淋巴细胞亚群与住院前临床转归之间的关系，以期在淋巴细胞谱中找到预测急性胰腺炎预后的指标。
对 48 例急性胰腺炎患者入院时的外周静脉血进行淋巴细胞亚群流式细胞术检测，并记录临床资料。主要观察终点为多器官功能衰竭（MOF）和感染。
根据是否存在感染对患者进行分组，两组间自然杀伤细胞存在显著差异（25.5±4.47[95%CI 14.4,36.6]比 14.8±7.62[95%CI 12.5,17.1]，P=0.021）。发生 MOF 的患者 CD4+CD25+CD127 细胞计数较低（4.49±1.5[MOF]比 6.57±2.65[非 MOF]，P=0.002），CD127low/high 细胞计数较高（1.35±0.66[MOF]比 0.97±0.44[非 MOF]，P=0.02）。MOF 患者的年龄显著更大（55±14.58[95%CI 48.49,61.42]比 46±15.59[95%CI 39.39,51.99]，P=0.04），急性生理学和慢性健康评估 II 评分更高（7±3.66[95%CI 5.5,7.64]比 4±2.89[95%CI 2.45,4.78]，P=0.001），C 反应蛋白水平更高（100.53±94.38[95%CI 58.69,142.48]比 50.8±59.2[95%CI 26.88,74.71]，P=0.04）。在多变量回归模型中，只有 CD4+CD25+CD127 细胞是预测非 MOF 的显著指标。对于非 MOF 的检测，CD4+CD25+CD127 细胞的受试者工作特征（ROC）曲线下面积为 0.74。
急性胰腺炎早期的 CD4+CD25+CD127 细胞对非 MOF 的检测具有良好的特异性，建议截断值为 6.41%。自然杀伤细胞较少的患者可能有发生继发感染的风险。
