【摘要】 目的:探讨脓毒症（Sepsis）患儿外周血CD₄⁺T淋巴细胞免疫球蛋白结合蛋白（Bip）、激活转录因子6（ATF6）及内质网应激（ERS）特异性促凋亡因子DNA损伤诱导转录蛋白3（DDIT3）mRNA水平的变化。方法:收集确诊脓毒症儿童60例,根据出院结局分为存活组和死亡组各30例,另外选取同期健康儿童30例作为对照组。对60例危重病例进行评分（PCIS）;采集三组外周静脉血标本,分离外周血CD₄⁺T淋巴细胞,实时荧光定量聚合酶链反应（Real-time PCR）法测定外周血CD₄⁺T淋巴细胞Bip、ATF6及DDIT3 mRNA的相对表达水平。PCR产物行琼脂糖凝胶电泳鉴定特异性。结果:脓毒症存活组C反应蛋白（CRP）、降钙素原（PCT）、白介素-6（IL-6）、血乳酸、D-二聚体及脑尿钠肽（BNP）均低于死亡组,PCIS评分高于死亡组,差异有统计学意义（t=7.77、11.40、21.88、5.11、9.53、4.27、2.80,均P<0.01）。三组Bip、ATF6及DDIT3 mRNA相对表达水平比较差异有统计学意义（F=586.49、313.55、764.23,均P<0.01）,存活组Bip、ATF6及DDIT3水平高于对照组[（3.01±0.67）与（1.00±0.32）、（2.17±0.37）与（1.00±0.28）、（4.44±0.64）与（1.00±0.20）],而低于死亡组[（3.01±0.67）与（6.63±0.84）、（2.17±0.37）与（3.26±0.39）、（4.44±0.64）与（10.02±1.41）]。存活组确诊时与治疗后Bip、ATF6及DDIT3 mRNA相对表达水平比较差异有统计学意义（t=16.31、19.20、39.10,均P<0.01）,存活组治疗后Bip、ATF6及DDIT3 mRNA相对表达水平低于确诊时水平。结论:脓毒症患儿外周血CD₄⁺T淋巴细胞Bip、ATF6及DDIT3表达水平增高,且随病情好转而降低,可通过ERS导致外周血CD₄⁺T细胞凋亡,从而在脓毒症多器官功能障碍综合征（MODS）的发生发展中起重要作用。更多还原

【Abstract】 Objective: To explore the changes of Bip（Immunoglobulin binding protein）, ATF6（Activating transcription factor 6） and DDIT3（DNA-damage-inducible transcript 3 protein）mRNA levels in peripheral blood CD₄⁺T cells of sepsis. Methods: This study was based on data from confirmed cases of septic children, who were grouped into survival group and death group in accordance with their discharge outcomes.According to the outcomes, they were divided into the survival group and the death group, 30 cases were selected randomly from both group and 30 healthy children served as the control group.Peripheral blood samples were collected, CD₄⁺ T cell were separated and Bip, ATF6 and DDIT3 mRNA levels were measured by real time polymerase chain reaction（Real-time PCR）. Specificity of PCR products were validated through agarose gel electrophoresis.Results: In the survival group CRP（C reactive protein）, PCT（Procalcitonin,）, IL-6（Interleukin-6）, lactic acid, D-dimer and BNP（Brain natriuretic peptide） were lower and PCIS scores were higher than the ones in the death group（t=7.77, 11.40, 21.88,5.11, 9.53, 4.27, 2.80, P<0.01）. The differences of Bip, ATF6 and DDIT3 mRNA levels of the control group, the survival group and the death group were statistically significant（F=586.49, 313.55, 764.23, P<0.01）. The expressions of Bip, ATF6 and DDIT3 of the survival group were significantly higher than that in the control group[（3.01±0.67） vs（1.00±0.32）,（2.17±0.37） vs（1.00±0.28）,（4.44±0.64） vs（1.00±0.20）] and lower than that in the death group[（3.01±0.67） vs（6.63±0.84）,（2.17±0.37） vs（3.26±0.39）,（4.44±0.64） vs（10.02±1.41）]. Conclusion: Sepsis in children increased the expressions of Bip, ATF6 and DDIT3 in CD₄⁺T lymphocytes, which may be related to the apoptosis of CD₄⁺T cell via endoplasmic reticulum stress, and then results in the occurrence and development of sepsis induced MODS（Multiple organ dysfunction syndrome）.更多还原