Chen Y, Li M, Liu J, Pan T, Zhou T, Liu Z, Tan R, Wang X, Tian L, Chen E, Qu H
Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Scand J Immunol. 2017 Aug;86(2):100-106. doi: 10.1111/sji.12564.
Acute pancreatitis (AP) with infectious complications has high mortality because of early-stage immunosuppression. The programmed cell death-1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway is an important host immunosuppression mechanism. Soluble PD-L1 (sPD-L1) expression regulates co-inhibitory signals in malignancies or autoimmune disorders; however, its effects in AP are unknown. Here, we evaluated whether serum sPD-L1 is involved in immune dysfunction and assessed its relationship with infectious complications in early AP. Blood samples were obtained from 56 patients with acute pancreatitis and 21 healthy individuals in this prospective study. Serum sPD-L1 levels within 48 h after AP onset were tested by enzyme-linked immunosorbent assays. Relevant immune parameters (human leucocyte antigen-DR, lymphocyte count) and inflammatory markers (C-reactive protein, white blood cell count) were analysed. sPD-L1 was significantly upregulated in patients with early AP, especially those with infectious complications, compared to healthy controls. Significant negative correlations were observed among monocyte HLA-DR expression, lymphocyte count and sPD-L1 levels in AP. Multivariate regression indicated that sPD-L1 was an independent risk factor for infectious complications in AP. The findings suggest that increased sPD-L1 expression appears to be involved in the development of immunosuppression in the early stage of AP and that sPD-L1 might be an early parameter for prediction of infectious complications in patients with AP.
伴有感染性并发症的急性胰腺炎（AP）由于早期免疫抑制而具有较高的死亡率。程序性细胞死亡蛋白1（PD-1）/程序性细胞死亡配体1（PD-L1）通路是一种重要的宿主免疫抑制机制。可溶性PD-L1（sPD-L1）表达调节恶性肿瘤或自身免疫性疾病中的共抑制信号；然而，其在AP中的作用尚不清楚。在此，我们评估血清sPD-L1是否参与免疫功能障碍，并评估其与早期AP感染性并发症的关系。在这项前瞻性研究中，从56例急性胰腺炎患者和21名健康个体中采集血样。通过酶联免疫吸附测定法检测AP发作后48小时内的血清sPD-L1水平。分析相关免疫参数（人类白细胞抗原-DR、淋巴细胞计数）和炎症标志物（C反应蛋白、白细胞计数）。与健康对照相比，早期AP患者，尤其是伴有感染性并发症的患者，sPD-L1显著上调。在AP患者中，单核细胞HLA-DR表达、淋巴细胞计数和sPD-L1水平之间存在显著负相关。多变量回归表明，sPD-L1是AP感染性并发症的独立危险因素。研究结果表明，sPD-L1表达增加似乎参与了AP早期免疫抑制的发展，并且sPD-L1可能是预测AP患者感染性并发症的早期参数。
