淋巴细胞亚群和细胞因子检测在脓毒症并发MODS中的应用价值  

Application value of lymphocyte subsets and cytokines detection in sepsis complicated with MODS

作　　者：张将[1] 吕金俊 ZHANG Jiang;LYU Jinjun(Department of Clinical Laboratory,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510080,China;Department of Clinical Laboratory,Guzhen People′s Hospital,Zhongshan,Guangdong 528421,China)

机构地区：[1]中山大学附属第一医院检验医学部,广东广州510080 [2]广东省中山市古镇人民医院检验科,广东中山528421

出　　处：《检验医学与临床》2024年第10期1396-1400,1405,共6页Laboratory Medicine and Clinic

摘　　要：目的分析淋巴细胞亚群和细胞因子检测在脓毒症并发多器官功能障碍综合征(MODS)中的应用价值。方法收集2022年1月至2023年6月中山大学附属第一医院符合《脓毒症与感染性休克的国际共识》中脓毒症诊断标准的脓毒症患者103例为研究对象,根据是否发生MODS分为MODS组(46例)与非MODS组(57例)。回顾性分析这两组患者的基线资料、淋巴细胞亚群、细胞因子和血清学指标,使用秩和检验比较两组患者淋巴细胞亚群、细胞因子与血清学指标水平,采用受试者工作特征曲线分析淋巴细胞亚群、细胞因子和血清学指标诊断脓毒症并发MODS的效能。结果MODS组CD3^(+)CD19^(-)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)T淋巴细胞水平明显低于非MODS组,差异均有统计学意义(P<0.05)。MODS组白细胞介素(IL)-2、IL-6、IL-10、肿瘤坏死因子(TNF)-α水平明显高于非MODS组,差异均有统计学意义(P<0.05)。CD3^(+)CD19^(-)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)T淋巴细胞诊断脓毒症并发MODS的曲线下面积(AUC)分别为0.899、0.711、0.676;IL-2、IL-6、IL-10、TNF-α诊断脓毒症患者MODS的AUC分别为0.637、0.797、0.761、0.650;PCT诊断脓毒症并发MODS的AUC为0.720。结论淋巴细胞亚群、细胞因子水平对诊断脓毒症并发MODS有一定价值,其中CD3^(+)CD19^(-)T淋巴细胞诊断灵敏度最高,IL-6诊断特异度最高。Objective To analyze the application value of lymphocyte subsets and cytokines detection in sepsis complicated with multiple organ dysfunction syndrome(MODS).Methods A total of 103 patients with sepsis who met the diagnostic criteria of sepsis in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to June 2023 were enrolled in this study.According to the presence or absence of MODS,they were divided into MODS group(46 cases)and non-MODS group(57 cases).The baseline data,lymphocyte subsets,cytokines and serological indicators of the two groups of patients were analyzed retrospectively.Rank sum test was used to compare the levels of lymphocyte subsets,cytokines and serological indicators of the two groups of patients.The receiver operating characteristic curve was used to analyze the efficacy of lymphocyte subsets,cytokines and serological indicators in the diagnosis of MODS in sepsis.Results The levels of CD3^(+)CD19^(-),CD3^(+)CD4^(+),CD3^(+)CD8^(+)T lymphocytes in MODS group were significantly lower than those in non-MODS group,the differences were statistically significant(P<0.05).The levels of interleukin(IL)-2,IL-6,IL-10 and tumor necrosis factor(TNF)-αin the MODS group were significantly higher than those in the non-MODS group,the differences were statistically significant(P<0.05).The area under the curve(AUC)of CD3^(+)CD19^(-),CD3^(+)CD4^(+),CD3^(+)CD8^(+)T lymphocytes in the diagnosis of MODS in sepsis patients were 0.899,0.711,0.676 respectively.The AUC of IL-2,IL-6,IL-10 and TNF-αin the diagnosis of sepsis complicated with MODS were 0.637,0.797,0.761 and 0.650 respectively.The AUC of PCT in the diagnosis of sepsis complicated with MODS was 0.720.Conclusion Lymphocyte subsets and cytokines levels have certain diagnostic value in predicting sepsis complicated with MODS,among which CD3^(+)CD19^(-)T lymphocyte has the highest diagnostic sensitivity,and IL-6 has the highest diagnostic specificity.

关 键 词：脓毒症 淋巴细胞亚群 细胞因子 多器官功能衰竭 诊断效能 

分 类 号：R446.63[医药卫生—诊断学]