外周血Th9和Th22细胞对急性呼吸窘迫综合征患者30天预后的预测价值  

Predictive value of Th9 and Th22 cells of peripheral blood in 30-day mortality of patients with acute respiratory distress syndrome

作　　者：高健敏[1] 朱勇德[1] 符国平[1] 林传钦 曾宗鼎[2] Gao Jian-min;Zhu Yong-de;Fu Guo-ping;Lin Chuan-qin;Zeng Zong-ding(Emergency Department,Sanya Central Hospital(the Third People's Hospital of Hainan Province),Sanya 572000,China)

机构地区：[1]三亚中心医院(海南省第三人民医院)急诊科,海南三亚572000 [2]三亚中心医院(海南省第三人民医院)呼吸与危重症医学科,海南三亚572000

出　　处：《中国急救医学》2021年第6期490-493,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的评估外周血Th9和Th22细胞对急性呼吸窘迫综合征(ARDS)患者30 d病死率的预测价值。方法选取2016年5月至2018年5月收治的ARDS患者95例,根据预后分为存活组(n=55)和死亡组(n=40)。比较两组患者年龄,性别,体重指数,发病诱因及入院时急性生理学与慢性健康状况Ⅱ(APACHE-Ⅱ)评分、Murray肺损伤评分和氧合指数(PaO2/FiO2);流式细胞术检测两组患者外周血Th9和Th22细胞表达水平;多因素Logistic回归分析ARDS患者死亡的危险因素,受试者工作特征曲线(ROC)评估各指标对ARDS患者30 d死亡的预测价值。结果两组患者的年龄、性别、体重指数和发病诱因等一般资料比较差异无统计学意义(P>0.05);死亡组患者入院时APACHEⅡ评分[(26.33±5.51)分vs.(23.92±5.74)分]和Murray评分[(2.61±0.51)分vs.(2.38±0.44)分]均高于存活组,而PaO2/FiO2[(141.47±9.32) mm Hg vs.(145.53±10.13) mm Hg]低于存活组,差异均有统计学意义(P<0.05);与存活组比较,死亡组患者外周血Th9[(6.49±0.68)%vs.(10.38±1.99)%]和Th22细胞[(4.38±0.35)%vs.(14.08±1.76)%]均显著升高(P<0.05)。多因素Logistic回归分析显示,Murray评分、PaO2/FiO2、Th9和Th22均是ARDS患者30 d内死亡的独立危险因素(P<0.05);Th9的曲线下面积(AUC)为0.788,95%置信区间(95%CI)为0.697-0.879,当最佳截断值为0.514时,敏感度为71.4%,特异度为80.0%;Th22的AUC为0.852,95%CI为0.773-0.931,当最佳截断值为0.657时,敏感度为80.2%,特异度为85.5%。结论外周血Th9和Th22细胞水平均是ARDS患者30 d内死亡的独立危险因素,但Th22对ARDS患者预后的预测价值优于Th9。Objective To observe the predictive value of Th9 and Th22 cells of peripheral blood in 30-day mortality of patients with acute respiratory distress syndrome( ARDS). Methods A total of95 patients with ARDS were randomly assigned to survival group( n = 55) and death group( n = 40).Age,gender,body mass index,predisposing factors,acute physiology and chronic health evaluationⅡ( APACHEⅡ) score,Murray lung injury score and oxygenation index( PaO2/FiO2) were compared between the two groups. The expression levels of Th9 and Th22 cells in peripheral blood of the two groups were detected by flow cytometry. The risk factors of death in the patients with ARDS were analyzed by multivariate Logistic regression,and the predictive value in the 30-day death of patients with ARDS was evaluated by receiver operating characteristic curve( ROC). Results There was no significant difference in age,gender,body mass index and predisposing factors between the two groups ( P>0. 05). APACHEⅡ score [( 26. 33 ± 5. 51) scores vs.( 23. 92 ± 5. 74) scores]and Murray score[( 2. 61 ± 0. 51) scores vs.( 2. 38 ± 0. 44) scores] in the death group were higher than those in the survival group,while PaO2/FiO2[( 141. 47 ± 9. 32) mm Hg vs.( 145. 53 ± 10. 13) mm Hg]was lower than that in the survival group( P<0. 05). The levels of Th9 cells [( 6. 49 ± 0. 68) % vs.( 10. 38 ±1. 99) %] and Th22 cells [( 4. 38 ± 0. 35) % vs.( 14. 08 ± 1. 76) %] in the death group were significantly higher than those in the survival group( P<0. 05). Multivariate Logistic regression analysis showed that Murray score,PaO2/FiO2,Th9 and Th22 cell were the independent risk factors for 30-day death of the patients with ARDS( P<0. 05). The area under the ROC curve( AUC) of Th9 cells was0. 788,95% CI was 0. 697-0. 879,and sensitivity was 71. 4% and specificity was 80. 0% when the cut-off value was 0. 514. The AUC of Th22 cells was 0. 852,95% CI was 0. 773-0. 931,and sensitivity was 80. 2% and specificity was 85. 5% when the cut-off value was 0. 657. Conclusions The leve

关 键 词：TH9细胞 TH22细胞 急性呼吸窘迫综合征(ARDS) 预后 

分 类 号：R563.8[医药卫生—呼吸系统]