脓毒症患者炎性因子和T淋巴细胞与病情严重程度和预后的关系  

Association of inflammatory factors and T lymphocytes with severity and prognosis of sepsis patients

作　　者：王晓艳[1] 史继静 李晓亮[1] 刘素霞[1] 曹焱[1] 薛亚爽 孔繁娇 刘超锋[2] WANG Xiao-yan;SHI Ji-jing;LI Xiao-liang;LIU Su-xia;CAO Yan;XUE Ya-shuang;KONG Fan-jiao;LIU Chao-feng(Zhengzhou First People's Hospital,Zhengzhou,Henan 450000,China;不详)

机构地区：[1]郑州市第一人民医院ICU,河南郑州450000 [2]山西医科大学第一医院呼吸内科,山西太原030000

出　　处：《中华医院感染学杂志》2024年第16期2439-2443,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关基金资助项目(LHGJ20230754);河南省医学科技攻关基金资助项目(LHGJ20230757)。

摘　　要：目的探究重症监护室(ICU)脓毒症患者炎性因子、T淋巴细胞及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分与病情严重程度和预后的关系。方法回顾性分析2022年8月-2023年8月郑州市第一人民医院收治的ICU(包括医院所有重症监护室)脓毒症患者135例的临床资料作为研究组,按照病情严重程度情况分为脓毒症组(75例)、脓毒性休克组(60例);随访28d,根据研究组的预后情况分为良好预后组(96例)和不良预后组(39例),另选同期来郑州市第一人民医院行健康体检的健康者145名作为对照组;比较研究组、对照组之间,脓毒症组、脓毒性休克组之间,良好预后组、不良预后组之间炎性因子、T淋巴细胞及APACHEⅡ评分情况;采用Spearman分析C-反应蛋白(CRP)、白细胞介素(IL)-6、降钙素原(PCT)、干扰素(IFN)-γ、CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)水平及APACHEⅡ评分与ICU脓毒症病情严重程度、预后的相关性。结果研究组CRP、IL-6、PCT、IFN-γ、CD_(8)^(+)水平及APACHEⅡ评分高于对照组,CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于对照组(P<0.05);脓毒性休克组CRP、IL-6、PCT、IFN-γ、CD_(8)^(+)水平及APACHEⅡ评分高于脓毒症组,CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于脓毒症组(P<0.05);与良好预后组相比,不良预后组CRP、IL-6、PCT、IFN-γ、CD_(8)^(+)水平及APACHEⅡ评分升高,CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)降低(P<0.05);CRP、IL-6、PCT、IFN-γ、CD_(8)^(+)水平及APACHEⅡ评分与ICU脓毒症患者病情严重程度均呈正相关(P<0.05),CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)则与ICU脓毒症患者病情严重程度呈负相关(P<0.05);CRP、IL-6、PCT、IFN-γ、CD_(8)^(+)水平及APACHEⅡ评分与ICU脓毒症患者不良预后均呈正相关(P<0.05),CD3^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)则与ICU脓毒症患者不良预后呈负相关(P<0.05)。结论ICU脓毒症患者的炎症因子水�OBJECTIVE To explore the correlation of inflammatory factors,T lymphocytes,acute physiology and chronic health status score Ⅱ(APACHEⅡ)with the severity and prognosis of sepsis in the intensive care unit(ICU).METHODS The clinical data of 135 patients with sepsis in ICU(including all the intensive-care unit in this hospital)admitted to the First People's Hospital of Zhengzhou from Aug 2022 to Aug 2023 were retrospectively analyzed.According to the severity of the disease,patients were divided into the sepsis group(75 cases)and the septic shock group(60 cases).After 28 days of follow-up,the study group was sub-divided into the good prognosis group(96 cases)and the bad prognosis group(39 cases)according to the prognosis.A total of 145 healthy volunteers under physical examination in the hospital during the same period were selected as the control group.The inflammatory factors,T lymphocytes and APACHEⅡ scores were compared between the study group and the control group,between the sepsis group and the septic shock group,and between the good prognosis group and the bad prognosis group.The correlation of C-reactive protein(CRP),interleukin(IL)-6,procalcitonin(PCT),interferon(IFN)-γ,CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+)and APACHEⅡ score with the severity and prognosis of sepsis in ICU was analyzed by Spearman.RESULTS The levels of CRP,IL-6,PCT,IFN-γ,CD_(8)^(+)and APACHEⅡ score in the study group were higher than those in the control group,while the levels of CD_(3)^(+),CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)were lower than those in the control group(P<0.05).The levels of CRP,IL-6,PCT,IFN-γ,CD_(8)^(+)and APACHEⅡ score in the sepsis shock group were higher than those in the sepsis group,while the levels of CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)were lower than those in the sepsis group(P<0.05).Compared with the good prognosis group,the poor prognosis group had significantly higher levels of CRP,IL-6,PCT,IFN-γ,CD_(8)^(+)and APACHEⅡ score,and significantly lower levels of CD_(3)^(+),CD_(4)^

关 键 词：重症监护室 脓毒症 炎性因子 T淋巴细胞 急性生理学与慢性健康状况评分系统Ⅱ 病情严重程度 预后 相关性 

分 类 号：R459.7[医药卫生—急诊医学]