【摘要】 背景 脓毒症是新生儿发病及死亡的重要原因，免疫系统在脓毒症的发展及恢复中起十分重要的作用，但目前关于新生儿发生脓毒症后机体免疫细胞变化的研究较少。目的 描述晚发型脓毒症（LOS）新生儿外周血中免疫细胞亚群的变化，并探讨免疫细胞亚群分布与近期预后的相关性。设计 病例对照研究。方法 纳入2015年10月至2017年10月于复旦大学附属儿科医院新生儿科住院的LOS新生儿为LOS组，并纳入与LOS组胎龄和出生体重相匹配的同期住院非感染新生儿为对照组。采用流式细胞术检测两组新生儿免疫细胞亚群的比例及绝对计数，包括多形核细胞（PMN）、单个核细胞（PBMC）、自然杀伤细胞（NK）、单核细胞（Mo）、T/B淋巴细胞。采用多因素Logistic回归分析探讨免疫细胞亚群分布与新生儿不良预后间的相关性。主要结局指标 LOS起病时（LOS起病后24 h内）和恢复期（LOS起病后7～10 d）免疫细胞亚群分布以及与预后的关系。结果 研究期间共纳入32例LOS新生儿（早产儿15例，足月儿17例），对照组28例（早产儿15例，足月儿13例）。LOS起病时，新生儿尤其是早产儿外周血中PMN细胞比例、CD14+/CD16+Mo细胞比例明显高于对照组；而CD3+T淋巴细胞，尤其是CD3+/CD4+T淋巴细胞明显低于对照组。LOS恢复期，NK细胞、T淋巴细胞（包括CD3+/CD4+T和CD3+/CD8+T细胞）水平显著升高，尤其是在足月儿中，升高趋势更明显。多因素回归分析显示，CD3+T细胞（aOR=-0.11,95%CI:-0.23～-0.01，P=0.044）和CD3+/CD4+T细胞（aOR=-0.16，95%CI:-0.32～-0.01，P=0.040）比例降低与严重脓毒症相关。结论 脓毒症发生时，早产儿与足月儿免疫细胞亚群变化不同；T淋巴细胞比例降低与严重脓毒症有关。更多还原

【Abstract】 Background Sepsis is a significant cause of morbidity and mortality in neonates.Immune system plays a crucial role in the development and recovery of sepsis.However,evidence on the changes of immune cells following neonatal sepsis onset is limited.Objective To describe the changes of immune cell subsets in neonates with late-onset sepsis and to explore the correla-tion between the distribution of immune cell subsets and short-term prognosis.Design A case-control study.Methods Neonates with late-onset sepsis (including both preterm and full-term infants) were enrolled as the sepsis group,and matched neonates with-out infectious diseases were included as the control group.Flow cytometry was used to detect the proportions and absolute counts of immune cell subsets,including polymorphonuclear cells (PMN),peripheral blood mononuclear cells (PBMC),natural killer cells (NK),monocytes (Mo),and T/B lymphocytes.Main outcome measures The distribution of immune cell subsets between the case and control groups during the onset and recovery phases of sepsis were compared.And the relationships between subset distri-bution and clinical outcomes were investigated.Results At the onset of sepsis,the proportions of PMN cells and CD14+/CD16+ monocytes in the peripheral blood of sepsis neonates,especially preterm infants,were significantly higher than those in the control group.In contrast,CD3+T lymphocytes,particularly CD3+/CD4+ T lymphocytes,were significantly lower than those in the control group.During the recovery period of sepsis,the levels of NK cells and T lymphocytes (including CD3+/CD4+ T cells and CD3+/CD8+ T cells) increased significantly,with a more pronounced upward trend in full-term infants.Multivariate regression analysis showed that reduced proportions of CD3+ T cells (aOR = -0.11,95% CI:-0.23,-0.01,P = 0.044) and CD3+/CD4+ T cells (aOR = -0.16,95% CI:-0.32,-0.01,P = 0.040) were associated with severe sepsis.Conclusion The changes in immune cell subsets differ between preterm and full-term infants during the sepsis onset.A reduced proportion of T lymphocytes is associated with severe sepsis.更多还原