Objective: The aim of the study was to explore the relationship between criticality, brain complications, and immune mechanisms in extracorporeal membrane oxygenation (ECMO) children with pneumonia and severe sepsis. Methods: Patients with simple pneumonia (group I), ECMO patients with pneumonia and severe sepsis accompanied by brain complications (group II), and those without brain complication (group III) admitted to our pediatric intensive care unit were selected to be investigated. The relationship among the peripheral blood subgroups of immune cells, immune factors, adaptive immune responses, endothelial factors, and criticality and brain complications was then studied. Results: Severe paralysis of normal immunity, excess abnormal immunity, and endothelial injury were consistent with the increase in the absolute value of base excess, lactic acid (Lac) content, and average hospitalization days and brain complications involved in group II (vs. group I). The ratio of CD63⁺ macrophage and CD63⁺ neutrophil subpopulation increased (p #x3c; 0.05); the expression levels of elastase⁺ neutrophil denatured subgroup (p #x3c; 0.05), the ratio of CCR2^highCX3CR1^low/CCR2^lowCX3CR1^high of macrophages and neutrophils (p #x3c; 0.0001), high-mobility group box 1 (HMGB1), YTHDF1, interleukin-17 protein and mRNA, and RAGE gene decreased to some extent (p #x3c; 0.05); the expression levels of Th1 cells chemokine CXCL9 protein and mRNA and sTIE2 protein increased to some extent (p #x3c; 0.05); the adaptive immune response of CD8⁺ CTL stimulated by lipopolysaccharide (LPS) was slightly enhanced (p #x3c; 0.05) in group III(vs. group II), which was consistent with the improvement of criticality, average hospitalization days, and the absence of brain complications in group III (vs. group II). Conclusion: ECMO support with brain complication was related to the upregulation of HMGB1 and YTHDF1 protein; the decreased number of CD63⁺ macrophages and neutrophils; the increased denatured neutrophil subgroup, especially the upregulated ratio of CCR2^highCX3CR1^low/CCR2^lowCX3CR1^high of macrophages and neutrophils; the imbalance of Th17/Th1, LPS-specific CD8⁺ CTL adaptive immune response paralysis; and the reduced endothelial sTIE2 protein expression level which caused clinical deterioration and prolonged average hospitalization days.
Neuroimmunomodulation

中文翻译：

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细胞免疫麻痹对严重脓毒症患儿体外膜氧合脑并发症的早期预后影响

目的：本研究旨在探讨体外膜肺氧合 (ECMO) 肺炎合并严重脓毒症患儿的危重程度、脑部并发症和免疫机制之间的关系。方法：选择收治于我院儿科重症监护病房的单纯性肺炎患者（Ⅰ组）、肺炎合并严重脓毒症伴脑部并发症的ECMO患者（Ⅱ组）和无脑部并发症的患者（Ⅲ组）进行调查。然后研究了免疫细胞的外周血亚群、免疫因子、适应性免疫反应、内皮因子、危重和脑部并发症之间的关系。结果：正常免疫严重瘫痪、异常免疫过度、内皮损伤与Ⅱ组（对比Ⅰ组）所涉及的碱过剩绝对值、乳酸（Lac）含量、平均住院天数和脑部并发症的增加一致. CD63 ⁺巨噬细胞和CD63 ⁺中性粒细胞亚群的比例增加（p #x3c；0.05）；弹性蛋白酶⁺中性粒细胞变性亚群的表达水平（p #x3c；0.05），巨噬细胞和中性粒细胞的CCR2^高CX3CR1^低/CCR2^低CX3CR1^高之比（p#x3c; 0.0001)、高迁移率族框 1 (HMGB1)、YTHDF1、白细胞介素 17 蛋白和 mRNA、RAGE 基因有一定程度的降低 ( p #x3c; 0.05)；Th1细胞趋化因子CXCL9蛋白和mRNA和sTIE2蛋白的表达水平有一定程度的升高（p #x3c；0.05）；脂多糖（LPS）刺激的CD8 ⁺ CTL的适应性免疫反应在III组（与II组相比）略有增强（p #x3c; 0.05），这与危急程度，平均住院天数和缺席的改善一致组 III（与组 II）的脑部并发症。结论： ECMO支持脑并发症与HMGB1和YTHDF1蛋白上调有关；CD63数量减少⁺巨噬细胞和中性粒细胞；增加的变性中性粒细胞亚群，尤其是巨噬细胞和中性粒细胞的CCR2^高CX3CR1^低/CCR2^低CX3CR1^高比例上调；Th17/Th1失衡，LPS特异性CD8 ⁺ CTL适应性免疫反应麻痹；以及导致临床恶化和平均住院天数延长的内皮 sTIE2 蛋白表达水平降低。
神经免疫调节