T淋巴细胞及亚群计数对重症急性胰腺炎患者预后的影响  

Effect of T-lymphocyte and subpopulation counts on the prognosis of patients with severe acute pancreatitis

作　　者：王伟琴 王瑞兰[1,2] 金姗姗 郑晶晶 俞戈 李明 Wang Weiqin;Wang Ruilan;Jin Shanshan;Zheng Jingjing;Yu Ge;Li Ming(Department of Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Shanghai Key Laboratory of Pancreatic Diseases,Shanghai 200080,China)

机构地区：[1]上海交通大学医学院附属第一人民医院急诊危重病科,上海200080 [2]上海市胰腺疾病重点实验室,上海200080

出　　处：《中华胰腺病杂志》2023年第1期28-32,共5页Chinese Journal of Pancreatology

基　　金：上海申康医院发展中心临床科技创新项目(SHDC22021211)。

摘　　要：目的探讨T淋巴细胞及亚群计数对SAP患者预后的影响。方法回顾性分析2019年1月至2022年6月间上海交通大学医学院附属第一人民医院确诊的90例SAP患者的临床资料,根据患者确诊28 d时预后情况分为预后良好组和预后不良组。记录患者的一般资料;确诊24 h内的血相关免疫学指标,包括白细胞,中性粒细胞,淋巴细胞,单核细胞,CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)T淋巴细胞数,CD_(4)^(+)/CD_(8)^(+)T淋巴细胞比例及免疫球蛋白G4水平;血炎症指标降钙素原、白蛋白水平及入院24 h的急性生理学和慢性健康状况(APACHEⅡ)评分;确诊28 d时患者的生存及并发症状况。采用非参数Mann-WhitneyU检验分析各指标与患者预后情况的相关性。绘制患者的受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估CD_(3)^(+)、CD_(4)^(+)T淋巴细胞预测SAP预后的价值。结果90例SAP患者中男性居多(65.6%),病因以胆源性为主(56.7%),高脂血症性次之(35.6%)。确诊28 d时存活85例(94.4%),其中39例痊愈,纳入预后良好组;46例合并感染、多器官功能障碍综合征(MODS)、胰腺局部并发症,死亡5例(5.56%),共51例纳入预后不良组。与预后良好组比较,预后不良组24 h内的CD_(3)^(+)[366(268,498)个/μl比709(578,999)个/μl]、CD_(4)^(+)[209(120,298)个/μl比486(303,548)个/μl]T淋巴细胞数及白蛋白水平(33.9 g/L比35.9 g/L)显著下降,而降钙素原水平(1.02 ng/ml比0.43 ng/ml)、APACHEⅡ评分[7(4,10)分比5(3,8)分]显著升高,差异均有统计学意义(P值均<0.05)。ROC曲线分析结果显示,24 h内的CD_(3)^(+)、CD_(4)^(+)T淋巴细胞数预测SAP预后不良的AUC值分别为0.857(95%CI 0.696~1.000)、0.867(95%CI 0.708~1.000),临界值分别为524个/μl、301个/μl,灵敏度均为85.7%,特异度分别为78.6%、85.7%。结论SAP确诊24 h内外周血CD_(3)^(+)、CD_(4)^(+)T淋巴细胞数量明显下降对SAP患者预后具有一定的预测价值。Objective To investigate the effect of T-lymphocyte and subpopulation counts on the prognosis of severe acute pancreatitis(SAP)patients.Methods The clinical data of 90 patients with SAP diagnosed at the Shanghai General Hospital between January 2019 and June 2022 were retrospectively analyzed,and the patients were divided into good prognosis and poor prognosis group according to whether they were diagnosed for 28 d.The general information of the patients was recorded,including blood-related immunological indicators within 24 h of diagnosis,including leukocytes,neutrophils,lymphocytes,monocytes,CD_(3)^(+),CD_(4)^(+),CD_(8)^(+)T-lymphocyte count and CD_(4)^(+)/CD_(8)^(+)T-lymphocyte ratio,IgG4 level;blood inflammation index procalcitonin,albumin level and APACHEⅡscore at admission;survival and complication status of patients at 28 d of diagnosis.Non-parametric Mann-Whitney U test was used to analyze the correlation between each index and the prognosis of the patients.The subject operating characteristic curve(ROC)of patients was plotted,and area under curve(AUC)was calculated to assess the value of CD_(3)^(+)and CD_(4)^(+)T-lymphocytes in predicting the prognosis of SAP.Results The majority of SAP patients were male(65.6%).The main cause of SAP was gallstone(56.7%),followed by hyperlipidemia(35.6%).At 28 days after diagnosis,85(94.4%)patients survived,and 39 of them were cured and included in the good prognosis group.Forty-six cases were complicated with infection,multiple organ dysfunction syndrome(MODS)and local pancreatic complications,and 5 cases(5.56%)died;and a total of 51 cases were included in the poor prognosis group.Compared with the good prognosis group,the number of CD_(3)^(+)T-lymphocytes[366(268,498)cells/μl vs 709(578,999)cells/μl],CD_(4)^(+)T-lymphocytes[209(120,298)cells/μl vs 486(303,548)cells/μl]and albumin level(33.9 g/L vs 35.9 g/L)within 24 hours in the poor prognosis group were significantly lower,while the level of procalcitonin(1.02 ng/ml vs 0.43 ng/ml)and APACHEⅡscore[7(4,10)vs 5(3

关 键 词：胰腺炎 急性坏死性 免疫系统 T淋巴细胞 预后 

分 类 号：R576[医药卫生—消化系统]