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目的:观察程序性细胞死亡受体-1/程序性细胞死亡受体配体-1（PD-1/PD-L1）调控树突状细胞（DC）对脓毒症患者免疫状态的影响，分析PD-1/PD-L1对脓毒症患者预后的预测价值。方法:从2018年10月至2019年9月住遵义医科大学附属医院综合重症监护病房（ICU）病区的脓毒症患者中采用随机数表法抽选25例，根据28 d预后将患者分为存活组（10例）和死亡组（15例）；同时随机抽取本院健康体检者20例作为健康对照组。脓毒症患者于确诊后24 h内、健康对照组于入组时取患者外周血，分离血清，采用流式细胞仪（FCM）检测CD4n +T、CD8n +T细胞比值，T细胞亚群比值（CD4/CD8），CD4n +T、CD8n +T细胞PD-1的表达，DC表面PD-L1、CD86的表达情况；采用酶联免疫吸附试验（ELISA）检测血清白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）的分泌水平；采用Spearman相关性分析法分析CD11cn +PD-L1与CD4n +PD-1、CD8n +PD-1、TNF-α、DC、CD11cn +CD86、T细胞亚群比值、CD4n +T细胞、CD8n +T细胞、IL-10的相关性；采用二元Logistic回归分析影响脓毒症患者死亡的危险因素，并绘制受试者工作特征曲线（ROC曲线），评价独立危险因素对患者预后的预测价值。n 结果:死亡组序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）均明显高于存活组〔SOFA评分（分）：15.1±4.1比10.7±2.7，APACHEⅡ评分（分）：27.0±7.3比17.0±3.9，均n P<0.05〕。存活组和死亡组T细胞亚群比值均<1，且死亡组CD4/CD8明显低于存活组（0.54±0.15比0.79±0.09，n P1。与健康对照组比较，存活组和死亡组CD4n +T细胞、CD8n +T细胞、CD11cn +DC、CD11cn +CD86、IL-10、TNF-α水平均明显降低，CD4n +PD-1、CD8n +PD-1、CD11cn +PD-L1水平均明显升高，且死亡组上述指标的变化较存活组更显著〔CD4n +T细胞：0.14±0.07比0.22±0.08，CD8n +T细胞：0.24±0.07比0.28±0.10，CD11cn +DC：0.84±0.14比0.93±0.03，CD11cn +CD86：（58.83±20.77）%比（78.24± 9.39）%，IL-10（ng/L）：34.22±13.98比18.49±5.55，TNF-α（ng/L）：95.30±29.33比67.00±20.16，CD4n +PD-1：（39.58±10.08）%比（27.03±6.35）%，CD8n +PD-1：（38.77±11.91）%比（29.15±8.37）%，CD11cn +PD-L1：（21.13±11.54）%比（12.11±8.34）%，均n P<0.05〕。Spearman相关性分析显示，CD11cn +PD-L1与CD4n +PD-1、CD8n +PD-1、IL-10呈正相关（n r值分别为0.748、0.713、0.898，均n P<0.05），与DC、CD11cn +CD86、T细胞亚群比值、CD4n +T细胞、CD8n +T细胞、TNF-α呈负相关（n r值分别为-0.587、-0.906、-0.840、-0.706、-0.513、-0.820，均n P<0.05）。多因素二元Logistic回归分析显示，CD4n +PD-1是影响脓素症患者预后的独立危险因素〔优势比（n OR）＝1.463，95%可信区间（95%n CI）为1.032~2.074，n P＝0.033〕；ROC曲线分析显示，CD4n +PD-1对脓毒症患者预后有一定预测价值〔ROC曲线下面积（AUC）＝0.857，95%n CI为0.709~1.000，n P<0.01〕；当最佳预测值为34.48%时，其敏感度为66.7%，特异度为90.0%，准确度85.7%。n 结论:外周血PD-1/PD-L1的上调会抑制DC的活化及增殖，影响T细胞活化，诱导脓毒症患者进入免疫抑制状态；PD-1/PD-L1可反映脓毒症患者的免疫状况，其中，CD4n +TPD-1对患者预后评估有一定价值。n “,”Objective:To study the effect of programmed cell death-1/programmed cell death-ligand 1 (PD-1/PD-L1) regulating dendritic cells (DC) on the immune status of sepsis, and analyze the effect of PD-1/PD-L1 on prognosis.Methods:Twenty-five patients with sepsis in the intensive care unit (ICU) of the Affiliated Hospital of Zunyi Medical University from October 2018 to September 2019 were collected and followed up for 28 days. According to the 28-day survival of patients, patients were divided into survival group and death group. Among them, 10 cases were in the survival group and 15 cases were in the death group. Simultaneously, 20 healthy subjects in our hospital during the same period served as the healthy control group. Peripheral blood of patients with sepsis was taken within 24 hours after diagnosis, and the healthy control group was taken at the time of enrollment. Flow cytometry was used to detect the proportion of CD4n +T and CD8n +T cells, the ratio of T cell subsets (CD4/CD8), the expression of PD-1 on CD4n +T and CD8n +T cells, and the expression of PD-L1 and CD86 in DC. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of interleukin-10 (IL-10) and tumor necrosis factor-α(TNF-α) in serum. Spearman correlation analysis was used to analyze the correlation between CD11cn +PD-L1 and CD4n +PD-1, CD8n +PD-1, TNF-α, DC, CD11cn +CD86, T cell subpopulation ratio, CD4n +T cells, CD8n +T cells, and IL-10. Binary Logistic regression was used to analyze the risk factors affecting the death of patients with sepsis, and receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of independent risk factors on the prognosis of patients.n Results:The scores of acute physiology and chronic health evaluationⅡ (APACHEⅡ) and sequential organ failure assessment (SOFA) in the death group were higher than that in the survival group (APACHEⅡ score: 27.0±7.3 vs. 17.0±3.9, SOFA score: 15.1±4.1 vs. 10.7±2.7, both n P < 0.05). The ratio of T cell subsets in the survival group and the death group was less than 1, the death group was lower than that in the survival group (CD4/CD8: 0.54±0.15 vs. 0.79±0.09, n P < 0.05), and the ratio of T cell subsets in the healthy control group was greater than 1. Compared with healthy control group, the levels of CD4 n +T cells, CD8n +T cells, CD11cn +DC, CD11cn +CD86, IL-10 and TNF-α in survival group and death group were significantly decreased, the level of CD4n +PD-1, CD8n +PD-1, CD11cn +PD-L1 were significantly increased, and the changes in the above indicators in the death group were significant compared with the survival group [CD4n +T cells: 0.14±0.07 vs. 0.22±0.08, CD8n +T cells: 0.24±0.07 vs. 0.28±0.10, CD11cn +DC: 0.84±0.14 vs. 0.93±0.03, CD11cn +CD86: (58.83±20.77)% vs. (78.24±9.39)%, IL-10 (ng/L): 34.22±13.98 vs. 18.49±5.55, TNF-α(ng/L): 95.30±29.33 vs. 67.00±20.16, CD4n +PD-1: (39.58±10.08)% vs. (27.03±6.35)%, CD8n +PD-1: (38.77±11.91)% vs. (29.15±8.37)%, CD11cn +PD-L1: (21.13±11.54)% vs. (12.11± 8.34)%, all n P < 0.05]. Spearman correlation analysis showed that CD11c n +PD-L1 was positively correlated with CD4n +PD-1, CD8n +PD-1, and IL-10 (n r values were 0.748, 0.713, 0.898, all n P < 0.05), while was negatively correlated with DC, CD11c n +CD86, T cell subpopulation ratio, CD4n +T cells, CD8n +T cells, and TNF-α(n r values were -0.587, -0.906, -0.840, -0.706, -0.513, -0.820, all n P < 0.05). Multivariate binary Logistic regression analysis showed that CD4 n +T PD-1 was an independent risk factor for the prognosis of sepsis patients [odds ratio (n OR) = 1.463, 95% confidence interval (95%n CI) = 1.032-2.074, n P = 0.033]. ROC curve analysis showed that CD4n +TPD-1 had certain predictive value for the prognosis of patients with sepsis [area under ROC curve (AUC) = 0.857, 95%n CI was 0.709-1.000, n P < 0.01). When the best predictive value was 34.48%, the sensitivity, specificity, and accuracy were 66.7%, 90.0%, and 85.7% respectively.n Conclusions:Up-regulation of PD-1/PD-L1 in peripheral blood could inhibit the activation and proliferation of DC, affect the activation of T cells, and induce immunosuppressive state. PD-1/PD-L1 can reflect the immune status of patients with sepsis. The expression of PD-1 on CD4n +T cells may have important significance for the evaluation of prognosis.n