Objective: To explore the changes of helper T lymphocytes 17 (Th17) and regulatory T lymphocytes (Tregs) in peripheral blood of patients with extensive burn at early stage in August 2nd aluminum dust explosion accident in Kunshan factory (hereinafter referred to as Kunshan explosion accident) and the significance. Methods: Twenty patients with extensive burn in Kunshan explosion accident admitted to our department of burns and plastic surgery were enrolled in burn group, and 10 healthy adult volunteers with no history of smoking were enrolled in healthy control group. Five mL of peripheral venous blood samples were collected from patients in burn group at admission (≤post injury hour 6, PIH 6) and PIH 24, and on post injury day (PID) 7, and from volunteers in healthy control group respectively. The percentages of CD64(+) T lymphocytes, human leukocyte antigen-DR positive (HLA-DR(+) ) T lymphocytes, CD3(+) CD8(-) Th17, and CD4(+) CD25(+) Tregs in peripheral blood T lymphocytes were determined by flow cytometer. Results: (1) The percentages of CD64(+) T lymphocytes in peripheral blood T lymphocytes of patients in burn group at admission and PIH 24 [(2.35±0.32)% and (4.02±0.15)%] were higher than (0.67±0.11)% of healthy volunteers in healthy control group. The percentage of CD64(+) T lymphocytes in peripheral blood T lymphocytes of patients in burn group on PID 7 [(0.39±0.25)% ] was lower than that of healthy volunteers in healthy control group. The percentages of HLA-DR(+) T lymphocytes in peripheral blood T lymphocytes of patients in burn group at admission and PIH 24 [(54±18)% and (72±17)%] were higher than (38±14)% of healthy volunteers in healthy control group. The percentage of HLA-DR(+) T lymphocytes in peripheral blood T lymphocytes of patients in burn group on PID 7 [(28±15)% ] was lower than that of healthy volunteers in healthy control group. (2) The percentages of CD3(+) CD8(-)Th17 in peripheral blood T lymphocytes of patients in burn group at admission and PIH 24 [(4.21±0.46)% and (7.38±0.39)%] were higher than (0.98±0.09)% of healthy volunteers in healthy control group. The percentage of CD3(+) CD8(-)Th17 in peripheral blood T lymphocytes of patients in burn group on PID 7 [(0.81±0.05)% ] was lower than that of healthy volunteers in healthy control group. (3) The percentages of CD4(+) CD25(+) Tregs in peripheral blood T lymphocytes of patients in burn group at admission and PIH 24, and on PID 7 [(1.78±0.26)%, (1.26±0.37)%, and (0.38±0.03)%] were lower than (3.24±0.52)% of healthy volunteers in healthy control group. Conclusions: The percentage of Th17 in peripheral blood T lymphocytes of patients with extensive burn at early stage in Kunshan explosion accident increased at first and then decreased compared with that of healthy volunteers, indicating that the patients' immune function increased first and then weakened. The percentages of Tregs in peripheral blood T lymphocytes at each time point were lower than the percentage of healthy volunteers, indicating that the patients' immunomodulation gradually weakened after extensive burns.
目的： 探讨"八二"昆山工厂铝粉尘爆炸事故(以下简称昆山爆炸事故)大面积烧伤患者早期外周血辅助性T淋巴细胞17(Th17)和调节性T淋巴细胞(Treg)的变化及意义。 方法： 选择笔者单位烧伤整形科在昆山爆炸事故中收治的20例大面积烧伤患者为烧伤组，10名健康无吸烟史成年志愿者作为健康对照组。烧伤组患者分别于入院时(≤伤后6 h)、伤后24 h、伤后7 d各采集外周静脉血5 mL，健康对照组志愿者采集外周静脉血5 mL。采用流式细胞仪检测外周血T淋巴细胞中CD64(＋)T淋巴细胞百分比、人类白细胞抗原DR阳性(HLA-DR(＋))T淋巴细胞百分比、CD3(＋)CD8(－)Th17百分比、CD4(＋)CD25(＋)Treg百分比。 结果： (1)烧伤组患者入院时、伤后24 h外周血T淋巴细胞中CD64(＋)T淋巴细胞百分比分别为(2.35±0.32)%、(4.02±0.15)%，均高于健康对照组志愿者的(0.67±0.11)%；烧伤组患者伤后7 d外周血T淋巴细胞中CD64(＋)T淋巴细胞百分比为(0.39±0.25)%，低于健康对照组志愿者。烧伤组患者入院时、伤后24 h外周血T淋巴细胞中HLA-DR(＋)T淋巴细胞百分比分别为(54±18)%、(72±17)%，均高于健康对照组志愿者的(38±14)%；烧伤组患者伤后7 d外周血T淋巴细胞中HLA-DR(＋)T淋巴细胞百分比为(28±15)%，低于健康对照组志愿者。(2)烧伤组患者入院时、伤后24 h外周血T淋巴细胞中CD3(＋)CD8(－) Th17百分比分别为(4.21±0.46)%、(7.38±0.39)%，均高于健康对照组志愿者的(0.98±0.09)%；烧伤组患者伤后7 d外周血T淋巴细胞中CD3(＋)CD8(－) Th17百分比为(0.81±0.05)%，低于健康对照组志愿者。(3)烧伤组患者入院时、伤后24 h、伤后7 d外周血T淋巴细胞中CD4(＋)CD25(＋)Treg百分比分别为(1.78±0.26)%、(1.26±0.37)%、(0.38±0.03)%，均低于健康对照组志愿者的(3.24±0.52)%。 结论： 昆山爆炸事故中大面积烧伤患者伤后早期外周血T淋巴细胞中Th17百分比较健康志愿者先增高后降低，说明免疫功能先增强后减弱；而各时间点外周血T淋巴细胞中Treg百分比均低于健康志愿者，说明大面积烧伤后患者的免疫调节逐步减弱。.
Keywords: Burns; Immunity, cellular; T-lymphocyte subsets; T-lymphocytes, regulatory.