CD4^(+)T细胞计数及单核细胞人类白细胞抗原⁃DR表达率在预测老年脓毒症患者预后中的价值  

Predictive value of CD4^(+)T cell count and expression rate of monocyte HLA⁃DR in prognosis of elderly pa⁃tients with sepsis

作　　者：伍松柏 何峻 WU Songbai;HE Jun(Department of Critical Care Medicine,the First Hospital of Changsha,Changsha 410005,China)

机构地区：[1]长沙市第一医院重症医学科,长沙410005

出　　处：《实用医学杂志》2021年第24期3148-3152,共5页The Journal of Practical Medicine

基　　金：湖南省卫生健康委员会科研计划项目(编号:B20182017)。

摘　　要：目的探讨CD4^(+)T细胞计数及单核细胞人类白细胞抗原⁃DR表达率在预测老年脓毒症患者预后的价值。方法109例老年脓毒症患者,分为死亡组(33例)、存活组(76例),比较两组免疫功能指标,如CD3^(+)T细胞计数、CD4^(+)T细胞计数、CD4^(+)/CD8^(+)T细胞比值及单核细胞人白细胞DR抗原表达率的差异并进行影响90 d内死亡因素的logistic回归及ROC曲线分析潜在指标预测90 d内死亡结局的准确性。结果死亡组治疗第1天及第7天CD3^(+)T细胞计数、CD4^(+)T细胞计数、单核细胞人白细胞DR抗原表达率均显著低于存活组(P<0.05)。入院后第1天CD4^(+)T细胞计数及单核细胞人类白细胞抗原⁃DR表达率并不是脓毒症90 d死亡的独立危险因素,而治疗第7天时CD4^(+)T细胞计数及单核细胞人类白细胞抗原⁃DR表达率是90 d死亡的独立危险因素并能够有效预测90 d死亡风险。CD4^(+)T细胞计数(AUC=0.847,95%CI:0.774~0.920)的预测最佳截断值为197.0 cells/μL,单核细胞人类白细胞抗原⁃DR表达率(AUC=0.898,95%CI:0.829~0.966)预测最佳截断值为40.5%。单核细胞人类白细胞抗原⁃DR表达率的准确性高于CD4^(+)T细胞计数,CD4^(+)T细胞计数联合单核细胞人类白细胞抗原⁃DR表达率(AUC=0.928,95%CI:0.883~0.974)预测特异性高于单个参数。结论老年脓毒症患者治疗第7天时CD4^(+)T细胞计数及单核细胞人类白细胞抗原⁃DR表达率是90 d死亡的独立危险因素,两者均为90 d死亡的有效预测指标,CD4^(+)T细胞计数及单核细胞人类白细胞抗原⁃DR表达率可以作为改善脓毒症预后的早期干预靶标。Objective To explore the value of CD4^(+)T cell count and the expression rate of mHLA⁃DR in predicting the prognosis of elderly patients with sepsis.Methods One hundred and nine elderly patients with sepsis were divided into death group(n=33)and survival group(n=76).The change of immunologic function indexes such as CD3^(+)T cell count and CD4^(+)T cell count and the ratio of CD4^(+)/CD8^(+)T cell count and the expression rate of monocyte HLA⁃DR were compared and analyzed.Multivariate logistic regression was used to analyze the influencing factors affecting the 90⁃day mortality and ROC curve to analyze the potential indicators in predicting the accuracy of the 90⁃day mortality.Results CD3^(+)T cell count,CD4^(+)T cell count and the expression rate of mono⁃cyte HLA⁃DR in death group at the 1st and the 7th day of treatment were significantly lower than those in survival group(P<0.05).CD4^(+)T cell count and the expression rate of monocyte HLA⁃DR at the 1st day of treatment were not independent risk factors for the 90⁃day mortality in sepsis.CD4^(+)T cell count(AUC=0.847,95%CI:0.774~0.920)and the expression rate of monocyte HLA⁃DR(AUC=0.898,95%CI:0.829~0.966)at the 7th day of treatment were independent risk factors for the 90⁃day mortality and they effectively predicted the risk of death.The predicted best cut⁃off value for CD4^(+)T cell count was 197.0 cells/μL and that for the expression rates of monocyte HLA⁃DR 40.5%.The accuracy of the expression rate of monocyte HLA⁃DR in predicting the 90⁃day mortality was higher than that of CD4^(+)T cell count.The prediction specificity of the expression rate of monocyte HLA⁃DR combined with CD4^(+)T cell count(AUC 0.928,95%CI 0.883~0.974)was higher than that of the single parameter.Conclusion The expression rate of monocyte HLA⁃DR and CD4^(+)T cell count on the 7th day of treatment are independent risk factors and effective predictors of the 90⁃day mortality in elderly patients with sepsis and they can be targets for early intervention to

关 键 词：脓毒症 老年 CD4+T细胞计数 单核细胞人类白细胞抗原⁃DR表达率 预后 

分 类 号：R453.9[医药卫生—治疗学]