脓毒症患者T淋巴细胞亚群水平与炎症状态动态变化的关系及对预后的影响  

Relationship between T lymphocyte subsets levels and dynamic changes of inflammation state and their effect on prognosis in patients with sepsis

作　　者：黄鑫波 刘端绘 莫旻龙 陈泽宇[1] 明静[1] 王勇湘 HUANG Xin-bo;LIU Duan-hui;MO Min-long;CHEN Ze-yu;MING Jing;WANG Yong-xiang(Intensive Care Unit,Wuzhou Red Cross Hospital,Wuzhou 543002,China)

机构地区：[1]广西梧州市红十字会医院重症医学科,梧州市543002

出　　处：《广西医学》2021年第23期2779-2784,共6页Guangxi Medical Journal

基　　金：广西梧州市科学研究与技术开发计划(201702004);广西医疗卫生重点学科建设项目(桂卫科教发[2019]19号)。

摘　　要：目的探讨脓毒症患者T淋巴细胞亚群水平与炎症状态动态变化之间的关系及对预后的影响。方法选取106例脓毒症患者作为观察组、40例健康体检者作为对照组。比较对照组体检当天与观察组入院第1天的T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、炎症状态指标[体温、心率、呼吸频率、急性生理和慢性健康评价系统Ⅱ(APACHEⅡ)评分及外周血白细胞计数、C反应蛋白(CRP)、降钙素原、内毒素]水平^(+)根据观察组入院后28 d的转归情况分为存活组(n=76)与死亡组(n=30),比较存活组与死亡组患者入院第1天、第4天、第7天的T淋巴细胞亚群水平、炎症状态指标水平及APACHEⅡ评分^(+)采用Pearson检验分析脓毒症患者T淋巴细胞亚群水平与炎症反应水平指标及APACHEⅡ评分的相关性。结果 (1)对照组患者入院第1天的外周血CD4^(+)、CD4^(+)/CD8^(+)水平均高于观察组,而体温、心率、呼吸频率、APACHEⅡ评分及外周血白细胞计数、血清CRP、血清降钙素原、血清内毒素、外周血CD8^(+)水平均低于观察组(均P<0.05)。(2)入院第7天,存活组患者的外周血CD4^(+)、CD4^(+)/CD8^(+)水平均高于死亡组,外周血CD8^(+)水平低于死亡组(均P<0.05)^(+)入院第4天及第7天,存活组患者的心率、呼吸频率、APACHEⅡ评分及外周血白细胞计数、血清CRP、血清降钙素原水平均低于死亡组,且入院第1天存活组的心率及APACHEⅡ评分、入院第7天存活组患者的体温及血清内毒素水平亦低于死亡组(均P<0.05)。(3)Pearson相关性分析结果显示,脓毒症患者的体温、心率、呼吸频率、APACHEⅡ评分及外周血白细胞计数、血清CRP、血清降钙素原、血清内毒素水平与外周血CD4^(+)、CD4^(+)/CD8^(+)水平均呈负相关,与外周血CD8^(+)水平均呈正相关(均P<0.05)。结论脓毒症患者发病早期即存在免疫功能紊乱及全身性炎症反应综合征,两者共同影响疾病预后,动态�Objective To investigate the relationship between T lymphocyte subsets levels and dynamic changes of inflammation state and their effect on prognosis in patients with sepsis. Methods A total of 106 patients with sepsis were enrolled as observation group, and 40 healthy check-up individuals were enrolled as control group. The levels of T lymphocyte subsets(CD4^(+), CD8^(+), CD4^(+)/CD8^(+)) and the levels of inflammation state indicators(body temperature, heart rate, respiratory rate, the Acute Physiology and Chronic Health Evaluation Ⅱ[APACHEⅡ] score, as well as WBC count, C-reactive protein[CRP], procalcitonin, and endotoxin in peripheral blood) in the control group on the day of the physical examination were compared with those in the observation group on the first day after admission. The observation group was divided into survival group(n=76) and death group(n=30) according to their outcomes 28 days after admission. The levels of T lymphocyte subsets, the levels of inflammation state indicators, and the APACHEⅡ score were compared between the survival group and the death group on the first, 4 th and 7 th day after admission. Pearson test was adopted to analyze the correlations of T lymphocyte subsets levels with the levels of inflammatory reaction indicators and the APACHEⅡ score in patients with sepsis. Results(1)On the first day after admission, the control group yielded higher peripheral blood levels of CD4^(+)and CD4^(+)/CD8^(+), decreased body temperature, heart rate, respiratory rate, and APACHEⅡ score, and lower levels of peripheral blood WBC count, serum CRP, serum procalcitonin, serum endotoxin, and peripheral blood CD8^(+)as compared with the observation group(all P<0.05).(2)On the 7 th day after admission, the survival group exhibited higher peripheral blood CD4^(+)and CD4^(+)/CD8^(+)levels and a lower peripheral blood CD8^(+)level than the death group(all P<0.05). On the 4 th and 7 th day after admission, the survival group reported reduced heart rate, respiratory rate and APACHEⅡ scor

关 键 词：脓毒症 T淋巴细胞亚群 炎症因子 预后 

分 类 号：R631[医药卫生—外科学]