中性粒细胞功能在脓毒症肝损伤中的变化及其对预后的影响:一项前瞻性观察性研究  

Changes in neutrophil function in septic liver injury and its effect on prognosis:a prospective observational study

作　　者：高飞 惠姣洁 杨岚 张江茜 于璇 陆士奇[1] Gao Fei;Hui Jiaojie;Yang Lan;Zhang Jiangqian;Yu Xuan;Lu Shiqi(Department of Emergency,the First Affiliated Hospital of Soochow University(the First Clinical Medical College of the Medical Department of Soochow University),Suzhou 215006,Jiangsu,China;Department of Intensive Care Unit,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214000,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院(苏州大学医学部第一临床医学院)急诊科,215006 [2]南京医科大学附属无锡人民医院重症医学科,214000

出　　处：《中华危重病急救医学》2019年第11期1324-1329,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81401619);江苏省医药卫生青年医学人才项目(QNRC2016178)。

摘　　要：目的探讨脓毒症肝损伤患者外周血中性粒细胞(PMN)功能变化及其对预后评价的指导作用。方法采用前瞻性观察性研究方法,选择2019年3月至8月南京医科大学附属无锡人民医院重症医学科(ICU)收治的符合脓毒症3.0诊断标准的患者作为研究对象,根据肝损伤诊断标准将患者分为脓毒症非肝损伤组和脓毒症肝损伤组;选择同期住院的非脓毒症患者作为非脓毒症组;选择本院体检中心健康体检者作为健康对照组。记录患者入ICU时及健康体检者体检当天的性别、年龄、白细胞计数(WBC)、PMN、降钙素原(PCT),计算患者急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评分(SOFA);记录患者28 d病死率;取外周静脉血,使用PicoGreen荧光染料定量检测血浆中性粒细胞胞外诱捕网(NETs)水平,以游离DNA(cf-DNA/NETs)水平表示;采用细胞免疫荧光染色进行NETs定性检测。提取健康对照组、脓毒症非肝损伤组、脓毒症肝损伤组PMN并进行体外培养,使用PicoGreen荧光染料定量检测细胞上清cf-DNA/NETs水平。根据脓毒症肝损伤患者28 d临床转归分组,绘制受试者工作特征曲线(ROC),并计算ROC曲线下面积(AUC),分析外周血NETs水平对脓毒症肝损伤患者预后的预测价值。结果最终纳入脓毒症非肝损伤患者21例,脓毒症肝损伤患者15例,非脓毒症患者20例,健康体检者20例。4组间性别、年龄差异均无统计学意义,说明各组一般资料均衡,具有可比性。脓毒症非肝损伤与肝损伤组外周血cf-DNA/NETs水平及WBC、PMN均明显高于健康对照组和非脓毒症组,PCT、APACHEⅡ评分、SOFA评分、28 d病死率均明显高于非脓毒症组,且脓毒症肝损伤组外周血cf-DNA/NETs水平及PCT、28 d病死率均明显高于脓毒症非肝损伤组〔cf-DNA/NETs(μg/L):481.60±275.86比169.76±57.05,PCT(μg/L):11.29(1.79,67.10)比1.11(0.19,4.09),28 d病死率:73.3%(11/15)比38.1%(8/21),均P<0.05〕。体外�Objective To explore the changes in polymorphonuclear neutrophils(PMN)function in peripheral blood of patients with sepsis and liver injury and its prognostic value.Methods A prospective observational study was conducted.The patients who met the criteria of Sepsis-3 admitted to intensive care unit(ICU)of Wuxi People's Hospital Affiliated to Nanjing Medical University from March to August in 2019 were enrolled as the research objects,and the patients were divided into sepsis without liver injury group and sepsis with liver injury group;non-sepsis patients who were hospitalized at the same time were enrolled as non-sepsis group;and the healthy people in the physical examination center were enrolled as healthy control group.The gender,age,white blood cell(WBC),PMN and procalcitonin(PCT)were recorded when the patients were admitted to ICU as well as the people on the day of physical examination.The acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)scores were calculated.The 28-day mortality was recorded.The quantitative level of neutrophil extracellular traps(NETs)which reflected by circulating free DNA(cf-DNA/NETs)in peripheral plasma was determined by PicoGreen fluorescence quantitative detection;the qualitative level of NETs was detected by immunofluorescence staining.PMN was extracted from the healthy control group,sepsis without liver injury group and sepsis with liver injury group and cultured in vitro,the quantitative level of cf-DNA/NETs in cell supernatant was determined by PicoGreen fluorescence quantitative detection.The patients were divided into two groups according to 28-day outcome of sepsis patients with liver injury.Receiver operating characteristic(ROC)curve was plotted,and the area under ROC curve(AUC)was calculated to analyze the prognostic value of NETs in sepsis patients with liver injury.Results Finally,21 sepsis patients without liver injury,15 sepsis patients with liver injury,20 with non-sepsis and 20 with healthy examination were enroll

关 键 词：中性粒细胞胞外诱捕网 脓毒症 肝损伤 预后 

分 类 号：R45[医药卫生—治疗学]