单核细胞HLA-DR百分比与单核细胞绝对计数联合应用对脓毒症预后的评估价值  

The prognostic value of combined use of monocyte HLA-DR and the absolute monocyte count in sepsis

作　　者：张智琪 汪浪 沈雪 张宇 黄月明 吴青青 ZHANG Zhi-qi;WANG Lang;SHEN Xue;ZHANG Yu;HUANG Yue-ming;WU Qing-qing(Department of Microbiology and Immunology,School of Clinical Laboratory Science,Guizhou Medical University,Guiyang,China 550004;Clinical Laboratory Center,Guizhou Medical University Hospital)

机构地区：[1]贵州医科大学医学检验学院临床微生物与免疫教研室,贵州贵阳550004 [2]贵州医科大学附属医院临床检验中心

出　　处：《中国病原生物学杂志》2021年第4期384-388,395,共6页Journal of Pathogen Biology

基　　金：国家自然科学基金项目(No.31460236)。

摘　　要：目的探讨外周血单核细胞人类白细胞抗原-DR(mHLA-DR)百分比联合单核细胞绝对计数(AMC)与脓毒症患者预后的相关性及其预测价值。方法选择2019年9月-2020年9月贵州医科大学附属医院收治的脓毒症患者33例,并根据28 d预后情况将其分为幸存组25例和非幸存组8例。记录患者一般资料、急性生理与慢性健康状况评估(APACHEⅡ)评分和序贯器官衰竭评估(SOFA)评分。比较两组患者外周血降钙素原(PCT)、中性粒细胞与淋巴细胞比值(NLR)、单核细胞绝对计数(AMC)和mHLA-DR表达水平的差异,采用单因素及多因素Logistic回归分析法分析脓毒症患者预后的危险因素,绘制受试者工作特征(ROC)曲线,评估不同指标对脓毒症患者的预后价值。结果非幸存组患者外周血PCT值6.04(1.03-20.16)ng/ml和NLR值13.69(7.86-24.21)均显著高于幸存组[2.18(0.54-9.50)ng/ml和和9.32(4.58-16.16)](P<0.05),而AMC(0.57±0.44)×10^(9)/L和mHLA-DR(52.54±19.40)%的水平均显著低于幸存组[(0.79±0.51)×10^(9)/L和(74.82±17.00)%](P<0.05);单因素及多因素Logistic回归分析结果显示,mHLA-DR是影响脓毒症患者28 d死亡的独立危险因素(OR=0.945,95%CI为0.922-0.969,P<0.01);ROC曲线分析结果显示,mHLA-DR预测脓毒症死亡的曲线下面积为0.814,最佳截断值为77.2%,敏感度为58.8%,特异性为96.7%,是脓毒症死亡的最佳预测因子,且当其与AMC联合应用时,曲线下面积为0.820,敏感度为96.7%,特异性为54.1%,显示出更高的评估价值。结论外周血PCT、NLR、AMC和mHLA-DR在不同预后的脓毒症患者中存在显著差异,mHLA-DR与AMC联合应用能提高脓毒症患者死亡的评估价值,可为临床提供参考。Objective To investigate the correlation between the percentage of human leukocyte antigen-DR(mHLA-DR) and the absolute count of monocytes(AMC) in peripheral blood and the prognosis for sepsis and the predictive value of those combined indices. Methods Subjects were a total of 33 patients with sepsis seen at Guizhou Medical University Hospital from September 2019 to September 2020 who were divided into survivors(25 cases) and non-survivors(8 cases) according to survival on day 28. The patients’ general information was recorded along with their Acute Physiology and Chronic Health Evaluation(APACHE II) score and Sequential Organ Failure Assessment(SOFA) score. The level of procalcitonin(PCT), the neutrophil-lymphocyte ratio(NLR), the absolute monocyte count(AMC), and the level of mHLA-DR in peripheral blood from the two groups were compared. The risk factors influencing the prognosis for patients with sepsis were analyzed using univariate and multivariate logistic regression analysis. Receiver operating characteristic(ROC) curves were plotted to evaluate the prognostic value of different indices. Results The PCT level in peripheral blood(6.04(1.03-20.16) ng/ml) and the NLR(13.69(7.86-24.21)) in non-survivors were significantly higher than those in survivors(2.18(0.54-9.50) ng/ml and 9.32(4.58-16.16))(P<0.05). The AMC(0.57±0.44×10^(9)/L) and the level of mHLA-DR(52.54±19.40%) were significantly lower than those in survivors(0.79±0.51×10^(9)/L and 74.82±17.00%)(P<0.05). Univariate and multivariate logistic regression analysis indicated that mHLA-DR was an independent risk factor for 28-d mortality in patients with sepsis(OR=0.945, 95%CI 0.922-0.969, P<0.01). ROC curve analysis indicated that mHLA-DR was the best predictor of death from sepsis;the area under the curve for predicting death from sepsis was 0.814 with a cutoff value of 77.2%;that index had a sensitivity of 58.8% and a specificity of 96.7%. mHLA-DR had greater value when combined with AMC;the area under the curve was 0.820, and the combined indice

关 键 词：脓毒症 人白细胞抗原-DR 单核细胞 中性粒细胞/淋巴细胞值 预后 

分 类 号：R392[医药卫生—免疫学]