Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Al-Saray st., Al-Manial, 11532, Egypt.
Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Al-Saray st., Al-Manial, 11532, Egypt.
Pathog Dis. 2019 Aug 1;77(6). doi: 10.1093/femspd/ftz055.
Understanding the complex immune responses in sepsis is crucial to provide insight into the clinical syndrome. We evaluated the changes in the surface receptors of the cells of innate immunity, neutrophils and monocytes, in patients with sepsis. Since sepsis remains a clinical challenge, we aimed to assess the significance of altered receptor expression in diagnosis and prognosis. Critically ill patients with sepsis (n=31) were investigated for the expression of receptors for IgG heavy chain CD64 and CD16 on neutrophils and CD64 and the lipopolysaccharide receptor CD14 on monocytes by flow cytometry and compared to 23 patients with no sepsis. Patients with sepsis had increased expression of neutrophil CD64. Neutrophil CD64 was specific for discriminating patients with sepsis but showed weak sensitivity. When integrated in a scoring system, neutrophil CD64 in combination with C-reactive protein (CRP) and SOFA score showed a diagnostic accuracy of 0.93 for sepsis and significantly predicted increased mortality risk. While neutrophil CD16 did not discriminate for sepsis, decreased expression was associated with increased mortality risk. In contrast, monocyte CD64 and CD14 expression was unaltered in sepsis and was not associated with mortality risk. Our study demonstrates that unlike monocytes, neutrophil receptor expression is altered in patients with sepsis receiving intensive care. It is promising to apply a combination approach to diagnose sepsis especially in time-limited conditions.
了解脓毒症中复杂的免疫反应对于深入了解临床综合征至关重要。我们评估了脓毒症患者固有免疫细胞（中性粒细胞和单核细胞）表面受体的变化。由于脓毒症仍然是一个临床挑战，我们旨在评估改变的受体表达在诊断和预后中的意义。通过流式细胞术检测了 31 例脓毒症危重症患者和 23 例无脓毒症患者中性粒细胞 IgG 重链 CD64 和 CD16 受体以及单核细胞 CD64 和脂多糖受体 CD14 的表达，并进行了比较。脓毒症患者中性粒细胞 CD64 表达增加。中性粒细胞 CD64 特异性区分脓毒症患者，但敏感性较弱。当整合到评分系统中时，中性粒细胞 CD64 与 C 反应蛋白（CRP）和 SOFA 评分相结合对脓毒症的诊断准确性为 0.93，并且显著预测了更高的死亡风险。虽然中性粒细胞 CD16 不能区分脓毒症，但表达降低与更高的死亡风险相关。相比之下，单核细胞 CD64 和 CD14 的表达在脓毒症中没有改变，与死亡风险无关。我们的研究表明，与单核细胞不同，接受重症监护的脓毒症患者中性粒细胞受体表达发生改变。应用联合方法诊断脓毒症，特别是在限时条件下，具有广阔的前景。
