外周血SAA和CD4^(+)、CD8^(+)T淋巴细胞计数对评估新型冠状病毒感染患者死亡风险的预测价值研究  

The predictive value of peripheral blood SAA,CD4^(+)and CD8^(+)T lymphocyte counts in evaluating the death risk of patients with novel coronavirus infection

作　　者：赵美芳[1] 盛美玲[1] 汪群智[1] 肖远超 ZHAO Meifang;SHENG Meiling;WANG Qunzhi;XIAO Yuanchao(Department of Respiratory and Critical Medicine,Jinhua People's Hospital in Zhejiang Province,Jinhua 321000,China)

机构地区：[1]浙江省金华市人民医院呼吸与危重症医学科,金华321000

出　　处：《浙江医学教育》2025年第1期54-59,共6页Zhejiang Medical Education

基　　金：2020年浙江省金华市科技局新型冠状病毒感染肺炎疫情应急防治科研攻关项目:“早期检测外周血SAA联合观察淋巴细胞及其亚群的动态变化对评估新型冠状病毒肺炎病情转归的意义研究”(2020XG-19);2020年浙江省金华市科技局新型冠状病毒感染肺炎疫情应急防治科研攻关项目:“血管紧张素转化酶及淋巴细胞亚群的分型对病毒感染的肺炎早期诊断及预后的意义”(2020XG-20)。

摘　　要：目的评估外周血血清淀粉样蛋白A(serum amyloid protein A,SAA)和CD4^(+)、CD8^(+)T淋巴细胞计数水平对评估新型冠状病毒感染(corona virus disease 2019,COVID-19)患者死亡风险的意义,为临床早期识别死亡高危患者提供依据。方法回顾性选取2023年1—2月在浙江省金华市人民医院诊治的382例COVID-19患者为研究对象,依据其确诊后30天内死亡情况分为死亡组(29例)和存活组(353例),记录其入院时外周血SAA和CD4^(+)、CD8^(+)T淋巴细胞计数水平。采用受试者工作特征(receiver operating characteristic,ROC)曲线研究上述指标预测COVID-19患者死亡风险的最佳阈值及相应的灵敏度和特异度。结果死亡组COVID-19患者外周血SAA水平高于存活组患者,外周血CD4^(+)、CD8^(+)T淋巴细胞计数低于存活组患者,其差异均具有统计学意义(均P<0.05)。外周血SAA预测COVID-19患者死亡风险的ROC曲线下面积为0.897,最佳截断值261.7 mg/L时灵敏度为85.2%、特异度为81.6%,Youden指数为0.668;外周血CD4^(+)细胞计数预测COVID-19患者死亡风险的ROC曲线下面积为0.909,最佳截断值192.4个/μL时灵敏度为89.3%、特异度为84.0%,Youden指数为0.733;外周血CD8^(+)细胞计数预测COVID-19患者死亡风险的ROC曲线下面积为0.934,最佳截断值167.7个/μL时灵敏度为92.9%、特异度为85.9%,Youden指数为0.788。结论外周血SAA和CD4^(+)、CD8^(+)T淋巴细胞计数水平可以作为COVID-19患者死亡风险预测的生物学指标。Objective To evaluate the significance of peripheral serum amyloid protein A(SAA)and CD4^(+),CD8^(+)T lymphocyte counts in assessing the death risk of patients with novel coronavirus infection(COVID-19),and to provide a theoretical basis for the early clinical identification of high-risk patients for death.Methods A retrospective study was conducted on 382 COVID-19 patients admitted to Jinhua People's Hospital in Zhejiang Province from January to February 2023.They were divided into a death group(29 people)and a survival group(353 people)based on their survival status within 30 days after diagnosis,and their peripheral blood SAA and CD4^(+),CD8^(+)T lymphocyte counts at admission were recorded.The receiver operating characteristic(ROC)curve was used to study the optimal threshold value of the above indicators for predicting the death risk of COVID-19 patients,as well as the corresponding sensitivity and specificity.Results The peripheral blood SAA level of COVID-19 patients in the death group was higher than that in the survival group,and the peripheral blood CD4^(+),CD8^(+)T lymphocyte counts were lower than those in the survival group,with all differences being statistically significant(all P<0.05).The area under the ROC curve for blood SAA predicting the death risk of COVID-19 patients was 0.897,with sensitivity of 85.2% and specificity of 81.6% at the optimal cutoff value of 261.7 mg/L,and Youden index of 0.668;the area under the ROC curve for blood CD4^(+)cell count predicting the death risk of COVID-19 patients was 0.909,with sensitivity of 89.3% and specificity of 84.0% at the optimal cutoff value of 192.4 cells/μL,and Youden index of 0.733;the area under the ROC curve for blood CD8^(+)cell count predicting the death risk of COVID-19 patients was 0.934,with sensitivity of 92.9%and specificity of 85.9%at the optimal cutoff value of 167.7 cells/μL,and Youden index of 0.788.Conclusions Peripheral blood SAA and CD4^(+),CD8^(+)T lymphocyte counts can be used as biological indicators for predicting the death r

关 键 词：新型冠状病毒 血清淀粉样蛋白A T淋巴细胞计数 死亡风险 预测 

分 类 号：R-563[医药卫生]