年龄联合CD4^(+)与CD8^(+)比值对多发伤并发持续炎症-免疫抑制-分解代谢综合征的预测价值  

Predictive value of age-combined CD4^(+)/CD8^(+)ratio in the multiple trauma complicated with persistent inflammation,immunosuppression and catabolism syndrome

作　　者：李娅[1] 王铭 李辉凤 潘险峰 Li Ya;Wang Ming;Li Hui-feng;Pan Xian-feng(The 920th Hospital of Joint Logistics Support Force Clinical College of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学联勤保障部队第九二〇医院临床学院,云南昆明650032 [2]联勤保障部队第九二〇医院急诊科,云南昆明650032

出　　处：《中国急救医学》2021年第11期932-937,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探索年龄联合辅助性T细胞(CD4^(+))与杀伤性T细胞(CD8^(+))比值对多发伤并发持续炎症-免疫抑制-分解代谢综合征(PICS)的预测价值。方法回顾性收集2017年1月至2020年12月入住联勤保障部队第九二〇医院急诊ICU的163例多发伤患者为研究对象,根据是否并发PICS将其分为多发伤并发PICS组(PICS组)及多发伤未并发PICS组(非PICS组),比较分析两组入院当天相关临床资料差异,筛选差异有统计学意义和可能影响预后的变量进行多因素Logistic分析,探索多发伤并发PICS的早期独立影响因素,并进一步绘制受试者工作特征(ROC)曲线评估其预测价值。结果本研究共纳入163例入住ICU多发伤患者,其中PICS组44例(27%),非PICS组119例(73%)。PICS组年龄[岁,49.5(43.0,60.5)vs.42.0(28.0,52.0)]、急性生理与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分[分,15.00(9.00,18.75)vs.9.00(5.00,12.00)]及序贯器官衰竭评分(SOFA)[分,5.00(3.00,7.75)vs.3.00(2.00,5.00)]高于非PICS组,差异有统计学意义(P<0.05),而两组性别比例、体重指数(BMI)、体温、创伤严重程度(ISS)评分、失血性休克比例、受伤机制及受伤部位差异无统计学意义(P>0.05)。PICS组淋巴细胞计数[×109/L,0.70(0.44,1.00)vs.0.91(0.60,1.36)]、白蛋白(g/L,27.99±6.31 vs.32.60±7.30)、碱剩余[mmol/L,-3.10(-5.38,-0.73)vs.-0.70(-3.70,2.40)]、CD4^(+)(%,32.80±13.47 vs.37.98±10.73)及CD4^(+)/CD8^(+)比值[%,1.11(0.71,1.84)vs.1.46(1.12,2.08)]低于非PICS组,差异有统计学意义(P<0.05);而葡萄糖[mmol/L,8.40(6.75,10.95)vs.7.60(6.50,8.80)]、降钙素原[ng/m L,2.29(0.35,7.77)vs.0.64(0.28,3.65)]、C-反应蛋白[mg/L,67.70(15.25,101.63)vs.32.90(12.60,68.90)]及血乳酸[mmol/L,2.35(1.43,3.90)vs.1.60(1.20,2.90)]高于非PICS组,差异有统计学意义(P<0.05),两组中性粒细胞计数、中性粒细胞/淋巴细胞比值、血小板计数、动脉血氧分压、动脉血二氧化碳分压、血酸碱度、凝血酶原时间、凝血酶时间、活化�Objective To explore the predictive value of age-combined CD4^(+)/CD8^(+)ratio in the multiple trauma complicated with persistent inflammation,immunosuppression and catabolism syndrome(PICS)in order to provide reference basis for early identification and prevention of PICS.Methods 163 patients with multiple trauma admitted to intensive care unit of our hospital from January2017 to December 2020 were observed retrospectively,and were divided into PICS group and non-PICS group according to the diagnostic criteria of PICS.The difference of clinical data between the two groups on the day of admission were compared and analyzed,a multivariate Logistic regression analysis was carried out on the indexes with statistical difference on admission day.To explore the early independent influencing factors of multiple trauma complicated with PICS and to draw a ROC curve to evaluate its prediction efficiency.Results A total of 163 patients with multiple trauma were enrolled,including 44 patients(27%)in PICS group and 119 patients(73%)in non-PICS group.The age[year:49.5(43.0,60.5)vs.42.0(28.0,52.0)],APACHEⅡscore[score:15.00(9.00,18.75)vs.9.00(5.00,12.00)]and SOFA score[score:5.00(3.00,7.75)vs.3.00(2.00,5.00)]of PICS group were significantly higher than those of non-PICS group(P<0.05),there was no significant difference in sex ratio,BMI,body temperature,ISS score,hemorrhagic shock ratio,injury mechanism and injury site between the two groups(P>0.05).The lymphocyte count[×109/L,0.70(0.44,1.00)vs.0.91(0.60,1.36)],albumin(g/L,27.99±6.31 vs.32.60±7.30),base excess[mmol/L,-3.10(-5.38,-0.73)vs.-0.70(-3.70,2.40)],CD4^(+)(%,32.80±13.47 vs.37.98±10.73)and CD4^(+)/CD8^(+)ratio[%,1.11(0.71,1.84)vs.1.46(1.12,2.08)]were significantly lower in PICS group than those in non-PICS group(P<0.05),whereas glucose[mmol/L,8.40(6.75,10.95)vs.7.60(6.50,8.80)],procalcitonin[ng/m L,2.29(0.35,7.77)vs.0.64(0.28,3.65)],C-reactive proteins[mg/L,67.70(15.25,101.63)vs.32.90(12.60,68.90)]and lactic acid[mmol/L,2.35(1.43,3.90)vs.1.60(1.20,2.90)]were higher

关 键 词：多发伤 持续炎症-免疫抑制-分解代谢综合征(PICS) T淋巴细胞亚群 危险因素 辅助性T细胞/杀伤性T细胞(CD4^(+)/CD8^(+)) 

分 类 号：R641[医药卫生—外科学]