CD4^(+)T淋巴细胞三磷酸腺苷对脓毒症患者预后的预测价值  

Value of adenosine triphosphate in CD4^(+)T lymphocytes to the prediction of prognosis of septic patients

作　　者：冼盈[1] 张扣兴[1] 毕筱刚[1] 郑常龙[2] 谢丹[1] XIAN Ying;ZHANG Kouxing;BI Xiaogang;ZHENG Changlong;XIE Dan(General Intensive Care Unit,Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510700,China;Department of Emergency,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510700,China)

机构地区：[1]中山大学附属第三医院岭南医院综合ICU,广东广州510700 [2]中山大学附属第三医院急诊科,广东广州510700

出　　处：《中华实用诊断与治疗杂志》2023年第12期1216-1221,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81500287)。

摘　　要：目的观察脓毒症患者外周血CD4^(+)T淋巴细胞三磷酸腺苷(ATP)表达情况,探讨其对脓毒症患者预后的预测价值。方法2021年10月—2022年8月中山大学附属第三医院岭南医院诊治脓毒症患者55例,根据疾病严重程度分为脓毒症组29例和脓毒症休克组26例,记录2组血乳酸、总胆红素、序贯器官衰竭评估(SOFA)评分等临床资料;确诊24 h时,采用流式细胞术检测2组外周血CD4^(+)、CD8^(+)T淋巴细胞百分比和亚群百分比,采用化学发光法检测CD4^(+)、CD8^(+)T淋巴细胞ATP水平。比较2组患者28 d病死率。绘制ROC曲线,评估外周血CD4^(+)T淋巴细胞ATP预测脓毒症患者预后不良的效能。根据CD4^(+)T淋巴细胞ATP水平最佳截断值(133.60μg/L),脓毒症休克ATP≤133.60μg/L者14例,其中8例(生存4例,死亡4例)于确诊1周时检测外周血CD4^(+)T淋巴细胞ATP水平,分别比较生存者、死亡者确诊24 h与确诊1周时CD4^(+)T淋巴细胞ATP水平。结果脓毒症休克组血乳酸[2.08(1.43,4.26)mmol/L]、总胆红素[26.56(11.93,101.14)μmol/L]、肌酐[207.50(98.75,257.75)μmol/L]水平及SOFA评分[11.00(8.00,14.75)分]均高于脓毒症组[1.50(1.09,1.88)mmol/L、16.00(8.20,23.48)μmol/L、103.00(78.00,164.00)μmol/L、7.00(4.00,11.00)分](P<0.05),CD4^(+)T淋巴细胞ATP水平[99.68(45.95,357.29)μg/L]、血小板计数[63.50(28.50,102.75)×10^(9)/L]均低于脓毒症组[236.90(137.20,414.70)μg/L、170.00(121.00,212.00)×10^(9)/L](Z=-2.158,P=0.031;Z=-3.642,P<0.001),年龄[(53.46±14.35)岁]小于脓毒症组[(64.07±16.33)岁](t=2.545,P=0.014),CD4^(+)、CD8^(+)T淋巴细胞百分比和亚群百分比、CD8^(+)T淋巴细胞ATP水平与脓毒症组比较差异均无统计学意义(P>0.05)。CD4^(+)T淋巴细胞ATP以133.60μg/L为最佳截断值,预测脓毒症患者预后不良的AUC为0.689(95%CI:0.543~0.802,P=0.029),灵敏度为77.14%,特异度为65.10%。脓毒症休克组28 d病死率(57.69%)高于脓毒症组(20.69%)(χ^(2)=7.952,P=0.005)。脓毒症休克ATP�Objective To observe the expression of adenosine triphosphate(ATP)in CD4^(+)T lymphocytes in septic patients,and to investigate its value to the prediction of prognosis of septic patients.Methods Fifty-five septic patients in Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University from October 2021to August 2022 were divided into sepsis group(n=29)and septic shock group(n=26)according to the severity of the disease.The clinical data such as blood lactate,total bilirubin and sequential organ failure assessment(SOFA)score were recorded in two groups.Within 24hafter diagnosis,the percentages of CD4^(+)and CD8^(+)T lymphocyte as well as CD4^(+)and CD8^(+)T lymphocyte subsets in peripheral blood were detected by flow cytometry in two groups.The ATP levels in CD4^(+)and CD8^(+)T lymphocytes were detected by chemiluminescence assay.The 28-day mortality was compared between two groups.ROC curves were plotted to evaluate the efficiency of ATP in CD4^(+)T lymphocytes on predicting poor prognosis of septic patients.ATP in CD4^(+)T lymphocytes was≤133.60μg/L(optimal cut-off value)in 14patients with septic shock,among whom 8patients(4survived,4died)were detected the ATP level in CD4^(+)T lymphocytes in peripheral blood at one week after diagnosis.The ATP levels in CD4^(+)T lymphocytes were compared in 24 h after diagnosis and in one week after diagnosis between the survived and died septic shock patients.Results The blood lactate level,total bilirubin,creatinine and SOFA score were higher in septic shock group[2.08(1.43,4.26)mmol/L,26.56(11.93,101.14)μmol/L,207.50(98.75,257.75)μmol/L,11.00(8.00,14.75)]than those in sepsis group[1.50(1.09,1.88)mmol/L,16.00(8.20,23.48)μmol/L,103.00(78.00,164.00)μmol/L,7.00(4.00,11.00)](P<0.05),the ATP level in CD4^(+)T lymphocytes and platelet count were lower in septic shock group[99.68(45.95,357.29)μg/L,63.50(28.50,102.75)×10^(9)/L]than those in sepsis group[236.90(137.20,414.70)μg/L,170.00(121.00,212.00)×10^(9)/L](Z=-2.158,P=0.031;Z=-3.642,P<0.001),the patients we

关 键 词：脓毒症 脓毒症休克 CD4+T淋巴细胞 三磷酸腺苷 免疫功能 预后 

分 类 号：R459.7[医药卫生—急诊医学]