严重烧伤患者早期外周血中性粒细胞趋化功能变化及影响因素

戚欣欣; 杨云稀; 孙炳伟

doi:10.3760/cma.j.cn501120-20190801-00329

严重烧伤患者早期外周血中性粒细胞趋化功能变化及影响因素

doi: 10.3760/cma.j.cn501120-20190801-00329

1. 江苏大学医学院,镇江 212000;
2. 南京医科大学附属苏州医院烧伤整形科 215008

基金项目:

国家自然科学基金（81772135、81471903）

江苏省重大科技专项（BE2017695）

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出版历程
- 收稿日期: 2019-08-01
- 网络出版日期: 2021-10-28
- 刊出日期: 2020-03-20

Early changes of chemotactic function of peripheral blood neutrophil of patients with severe burns and the influence factor

1. School of Medicine, Jiangsu University, Zhenjiang 212000, China;
2. Department of Burns and Plastic Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215008, China

摘要

摘要: 目的观察严重烧伤患者早期外周血中性粒细胞趋化功能变化及影响因素。方法将2019年1—5月南京医科大学附属苏州医院收治的符合入选标准的7例伤后6 h内入院的严重烧伤患者纳入烧伤组[男4例、女3例，年龄(36±10)岁]，同期招募该单位体检中心体检结果正常的7名健康志愿者纳入健康对照组[男5名、女2名，年龄为(35±8)岁]，进行前瞻性对照研究。(1)烧伤组患者于入院后1、3、5 d各抽取2 mL静脉血，健康对照组志愿者取2 mL静脉血，常规检测白细胞计数、血小板计数、中性粒细胞计数及血清降钙素原、C反应蛋白水平。(2)同前取烧伤患者和健康志愿者静脉血，酶联免疫吸附测定法检测白细胞介素6(IL-6)、IL-10、肿瘤坏死因子α(TNF-α)水平。(3)同前取烧伤患者和健康志愿者静脉血，Ficoll密度梯度离心法分离外周血中性粒细胞，琼脂糖趋化实验检测细胞趋化距离，流式细胞仪仅检测烧伤组患者入院后3 d及健康对照组志愿者趋化因子受体CXCR1、CXCR2阳性表达率。对数据行重复测量方差分析、t检验及Bonferroni校正。结果 (1)烧伤组患者入院后1、3、5 d血小板计数与健康对照组志愿者相近(t＝0.55、0.44、0.12，P>0.05)。烧伤组患者入院后1、3、5 d中性粒细胞计数、白细胞计数及血清降钙素原、C反应蛋白表达水平均明显高于健康对照组志愿者(t＝196.96、273.31、45.22，3.46、4.18、5.55，4.36、5.26、11.13，64.94、89.97、84.31, P<0.01)。(2)烧伤组患者入院后1、3、5 d IL-6水平明显高于健康对照组志愿者(t＝187.43、213.54、195.74，P<0.01)，IL-10水平明显高于健康对照组志愿者(t＝21.47、11.13、6.23，P<0.01)，TNF-α水平明显高于健康对照组志愿者(t＝5.27、7.89、15.58，P<0.01)。(3)烧伤组患者入院后1、3、5 d中性粒细胞趋化距离分别为(1 479±102)、(1 395±82)、(1 017±91)μm，明显短于健康对照组志愿者的(1 902±120)μm，t＝7.11、9.23、15.55，P<0.01。(4)烧伤组患者入院后3 d中性粒细胞CXCR1、CXCR2阳性表达率分别为(48.3±1.6)%、(79.0±1.8)%，明显低于健康对照组志愿者的(95.4±4.5)%、(97.8±2.1)%，t＝27.13、23.10，P<0.01。结论严重烧伤患者早期外周血中性粒细胞趋化功能障碍，这可能与CXCR1、CXCR2降低有关。
- 烧伤 /
- 趋化作用 /
- 受体，趋化因子 /
- 中性粒细胞
Abstract: Objective To observe the early changes of chemotactic function of peripheral blood neutrophil of patients with severe burns and the influence factor. Methods Seven severe burn patients who met the inclusion criteria and were admitted to Suzhou Hospital Affiliated to Nanjing Medical University in 6 hours post burns from January to May 2019 were selected and included in burn group (4 males and 3 females, aged (36±10) years). Seven healthy volunteers with normal physical examination results in the Physical Examination Center of the same hospital in the same period of time were included in healthy control group (5 males and 2 females, aged (35±8) years). A prospective and controlled study was performed. (1) The venous blood of 2 mL was taken from each patient in burn group on post admission day (PAD) 1, 3, 5 and venous blood of 2 mL was taken from each volunteer in healthy control group for routine detection of white blood cell count, platelet count, neutrophil count, serum procalcitonin level, and C-reactive protein level. (2) The venous blood of patients and healthy volunteers was taken as before for measuring interleukin-6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. (3) The venous blood of patients and healthy volunteers was taken as before, and peripheral blood neutrophils were isolated by Ficoll density gradient centrifugation. The chemotactic distance of neutrophil was detected by agarose chemotaxis test, and the positive expression rates of chemokine receptor CXCR1 and CXCR2 of patients in burn group on PAD 3 and volunteers in healthy control group were detected by flow cytometer. Data were statistically analysed with analysis of variance for repeated measurement, t test, and Bonferroni correction. Results (1) The platelet count of patients in burn group on PAD 1, 3, 5 was close to that of volunteers in healthy control group respectively (t=0.55, 0.44, 0.12, P>0.05). The counts of neutrophil and white blood cell and the expression levels of serum procalcitonin and C-reactive protein of patients in burn group on PAD 1, 3, 5 were significantly higher than those of volunteers in healthy control group (t=196.96, 273.31, 45.22, 3.46, 4.18, 5.55, 4.36, 5.26, 11.13, 64.94, 89.97, 84.31, P<0.01). (2) The level of IL-6 of patients in burn group on PAD 1, 3, 5 was significantly higher than that of volunteers in healthy control group respectively (t=187.43, 213.54, 195.74, P<0.01), the level of IL-10 of patients in burn group on PAD 1, 3, 5 was significantly higher than that of volunteers in healthy control group respectively (t=21.47, 11.13, 6.23, P<0.01), and the level of TNF-α of patients in burn group on PAD 1, 3, 5 was significantly higher than that of volunteers in healthy control group respectively (t=5.27, 7.89, 15.58, P<0.01). (3) The chemotactic distances of neutrophil of patients in burn group were (1 479±102), (1 395±82), and (1 017±91) μm respectively on PAD 1, 3, 5, which were significantly shorter than (1 902±120) μm of volunteers in healthy control group (t=7.11, 9.23, 15.55, P<0.01). (4) The CXCR1 and CXCR2 positive expression rates of neutrophil of patients in burn group on PAD 3 were (48.3±1.6)% and (79.0±1.8)%, respectively, which were significantly lower than (95.4±4.5)% and (97.8±2.1)% of volunteers in healthy control group (t=27.13, 23.10, P<0.01). Conclusions The chemotactic dysfunction of peripheral blood neutrophil was detected in the early stage of severe burn patients, which may be related to the decreases of CXCR1 and CXCR2.
- Burns /
- Chemotaxis /
- Receptors, chemokine /
- Neutrophils