脓毒症患者淋巴细胞亚群分析及其对预后的影响  

Analysis of lymphocyte subsets in patients with sepsis and its impact on prognosis

作　　者：杨宏富[1] 李平娜 崔秋敏 马宁 刘启龙[1] 孙小鸽 孙荣青[1] Yang Hongfu;Li Pingna;Cui Qiumin;Ma Ning;Liu Qilong;Sun Xiaoge;Sun Rongqing(Department of Intensive Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China)

机构地区：[1]郑州大学第一附属医院重症医学科,河南郑州450052

出　　处：《中华危重病急救医学》2023年第7期702-706,共5页Chinese Critical Care Medicine

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190213)。

摘　　要：目的探讨重症监护病房(ICU)脓毒症患者外周血淋巴细胞亚群的变化特点及预测预后的价值。方法回顾性分析2020年1月至2021年12月郑州大学第一附属医院外科重症监护病房(SICU)收治的符合脓毒症3.0诊断标准且年龄≥18周岁患者的临床资料。所有患者均于入住SICU次日清晨抽取外周静脉血检测血常规及外周血淋巴细胞亚群。根据28 d生存情况将患者分为两组,比较两组免疫指标的差异。采用Logistic回归分析影响预后的免疫指标危险因素。结果①试验共纳入脓毒症患者279例,其中28 d生存198例(28 d生存率71.0%),死亡81例(28 d病死率29.0%)。死亡组与存活组年龄(岁:57.81±1.71比54.99±1.05)、性别(男性:60.5%比63.6%)比较差异无统计学意义(均P>0.05),基线资料具有可比性。②死亡组急性生理学与慢性健康状况评分Ⅱ〔APACHEⅡ(分):22.06±0.08比14.08±0.52,P<0.001〕、中性粒细胞百分比〔NEU%:(88.90±1.09)%比(84.12±0.77)%,P=0.001〕、降钙素原〔PCT(μg/L):11.97±2.73比5.76±1.08,P=0.011〕、血小板分布宽度(fL:16.81±0.10比16.57±0.06,P=0.029)明显高于存活组,而淋巴细胞百分比〔LYM%:(6.98±0.78)%比(10.59±0.86)%,P=0.012〕、淋巴细胞计数〔LYM(×109/L):0.70±0.06比0.98±0.49,P=0.002〕、血小板计数〔PLT(×109/L):151.38±13.96比205.80±9.38,P=0.002〕、血小板压积〔(0.15±0.01)%比(0.19±0.07)%,P=0.012〕均低于存活组。③死亡组与存活组在淋巴细胞各亚群百分比水平差异均无统计学意义,但死亡组LYM绝对值(个/μL:650.24±84.67比876.64±38.02,P=0.005)、CD3+绝对值(个/μL:445.30±57.33比606.84±29.25,P=0.006)、CD3+CD4+绝对值(个/μL:239.97±26.96比353.49±18.59,P=0.001)、CD19+绝对值(个/μL:111.10±18.66比150.30±10.15,P=0.049)均低于存活组。死亡组其余各淋巴细胞亚群,如CD3+CD8+绝对值(个/μL:172.40±24.34比211.22±11.95,P=0.112)、自然杀伤细胞(NK)绝对值(个/μL:101.26±18.15比114.72±7.64,P=0.420)�Objective To explore the characteristics of changes in peripheral blood lymphocyte subsets in patients with sepsis in intensive care unit(ICU)and analyze their predictive value for prognosis.Methods The clinical data of sepsis patients admitted to the surgical intensive care unit(SICU)of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were analyzed retrospectively.The patients met the diagnostic criteria of Sepsis-3 and were≥18 years old.Peripheral venous blood samples were collected from all patients on the next morning after admission to SICU for routine blood test and peripheral blood lymphocyte subsets.According to the 28-day survival,the patients were divided into two groups,and the differences in immune indexes between the two groups were compared.Logistic regression analysis was used to analyze the risk factors of immune indexes that affect prognosis.Results①A total of 279 patients with sepsis were enrolled in the experiment,of which 198 patients survived at 28 days(28-day survival rate 71.0%),and 81 patients died(28-day mortality 29.0%).There were no significant differences in age(years old:57.81±1.71 vs.54.99±1.05)and gender(male:60.5%vs.63.6%)between the death group and the survival group(both P>0.05),and the baseline data was comparable.②Acute physiology and chronic health evalutionⅡ(APACHEⅡ:22.06±0.08 vs.14.08±0.52,P<0.001),neutrophil percentage[NEU%:(88.90±1.09)%vs.(84.12±0.77)%,P=0.001],procalcitonin[PCT(μg/L):11.97±2.73 vs.5.76±1.08,P=0.011],platelet distribution width(fL:16.81±0.10 vs.16.57±0.06,P=0.029)were higher than those in the survival group,while lymphocyte percentage[LYM%:(6.98±0.78)%vs.(10.59±0.86)%,P=0.012],lymphocyte count[LYM(×109/L):0.70±0.06 vs.0.98±0.49,P=0.002],and platelet count[PLT(×109/L):151.38±13.96 vs.205.80±9.38,P=0.002],and thrombocytocrit[(0.15±0.01)%vs.(0.19±0.07)%,P=0.012]were lower than those in the survival group.③There was no statistically significant difference in the percentage of lymphocyte s

关 键 词：淋巴细胞亚群 脓毒症 预后 

分 类 号：R459.7[医药卫生—急诊医学]