An increased alveolar CD4+CD25+Foxp3+T-regulatory cell ratio in acute respiratory distress syndrome is associated with increased 30-day mortality

作者：Adamzik Michael; Broll Jasmin; Steinmann Joerg; Westendorf Astrid Maria; Rehfeld Irene; Kreissig Carla; Peters Juergen^*

来源：Intensive Care Medicine, 2013, 39(10): 1743-1751.

DOI：10.1007/s00134-013-3036-3

• T-regulatory cell
• ARDS
• 30-Day mortality
• Bronchoalveolar lavage
• BAL cytokines
• Pneumonia

Cell therapy may become an option for lung injury treatment. However, no data are available on the alveolar presence and time course of CD4+ CD25 + Foxp3 + T-regulatory lymphocyte cells (Tregs) in acute respiratory distress syndrome (ARDS). Accordingly, we (1) measured the ratio of CD4 + CD25 + Foxp3 + Tregs to all (CD4+) lymphocytes in the bronchoalveolar lavage (BAL) of ARDS patients and of control subjects without lung disease and (2) assessed their impact on 30-day mortality. %26lt;br%26gt;In a prospective study, the ratios of CD4 + CD25 + Foxp3 + T-regulatory cells to all CD4+ cells were measured (FACS) within 24 h of the patients%26apos; ICU referral in the BAL and in the blood of 47 patients with ARDS (32 males, 15 females; mean age 44 years +/- 13) as well as in 8 controls undergoing elective abdominal surgery (5 men, 3 women; mean age 49 years +/- 4). BAL concentrations of several cytokines were also measured in ARDS patients. %26lt;br%26gt;Tregs were detected in the BAL of control subjects and ARDS patients. However, the mean ratio of Tregs to all CD4+ lymphocytes was threefold greater in ARDS non-survivors (16.5 %; p = 0.025) and almost twofold greater in ARDS survivors (9.0 %; p = 0.015) compared to controls (5.9 %). Multivariate Cox regression analysis revealed the ratio of CD4 + CD25 + Foxp3 + T-regulatory lymphocytes to all CD4+ lymphocytes in the BAL to be an important and independent prognostic factor for 30-day survival (HR 6.5; 95 % CI, 1.7-25; p = 0.006). %26lt;br%26gt;An increased T-regulatory cell ratio in the admission BAL of patients with ARDS is an important and independent risk factor for 30-day mortality.

• 出版日期2013-10
• 单位河北医科大学