细胞免疫功能测定在危重症患者中的临床意义

Clinical significance of cellular immune function determination in critical patients

目的探讨细胞免疫功能与危重症患者病情严重程度和预后的关系。方法选择资料完整的危重症患者43例,根据28d生存情况,将患者分为存活组(21例)及死亡组(22例),并通过急性病生理学和长期健康评价(APACHE)Ⅱ评分计算出分值,采用流式细胞仪对T淋巴细胞亚群及自然杀伤(NK)细胞进行检测。结果与存活组比较,死亡组外周血T淋巴细胞CD3+、CD4+及CD8+细胞计数低于存活组,差异均具有统计学意义([270.32±187.58)、(189.27±156.99)、(88.73±56.74),(489.05±109.18)、(342.05±116.41)、(170.33±68.69)个/μl,P均<0.05];死亡组外周血T淋巴细胞CD3+、CD4+、CD8+及NK细胞百分数低于存活组,差异均具有统计学意义([43.07±10.35)%、(21.88±8.04)%、(13.71±6.27)%、(7.35±4.46)%,(52.91±13.24)%、(29.76±6.02)%、(24.45±10.78)%、(14.35±5.03)%,P均<0.05]。存活组和死亡组患者APACHEⅡ评分与CD3+、CD4+、CD8+细胞计数均呈负相关(P均<0.05),而与CD3+、CD4+、CD8+及NK细胞百分数均无相关性(P均>0.05)。结论细胞免疫功能水平高低与危重症患者病情严重程度有关。细胞免疫功能水平可作为评估危重症患者病情和预后的重要检测指标。

Objective To investigate the relation between cellular immune function and the severity and prognosis of critical patients. Methods Forty-three critical patients withcomplete data were selected and divided into survival group（21 cases） and death group（22 cases） . Acute physiology and chronic health evaluation（APACHE） II was used to calculate scores of the two groups. Flow cytometry was conducted to determine T lymphocyte subsets and natural killer（NK） cells. Results In the death group,the CD3＋,CD4＋,CD8＋ cell counts were apparently lower than the survival group [（270.32±187.58） ,（189.27±156.99） ,（88.73±56.74） /μl vs.（489.05±109.18） ,（342.05±116.41） ,（170.33±68.69） /μl,respectively,all P0.05]. Furthermore,in the death group,the percentages of CD3＋,CD4＋,CD8＋ and NK cells weresignificantly lower than the survival group [（43.07±10.35） %,（21.88±8.04） %,（13.71±6.27） %,（7.35±4.46） % vs.（52.91±13.24） %,（29.76±6.02） %,（24.45±10.78） %,（14.35±5.03） %,respectively,all P0.05]. The APACHEⅡscores were negatively correlated with CD3＋,CD4＋,CD8＋ cell counts in both two groups（all P0.05） . However,no correlation was found between theAPACHEⅡ scores and the percentages of CD3＋,CD4＋,CD8＋ and NK cells（all P0.05） . Conclusions The cellular immune function changes is related to the condition severity. Therefore,it can be used as an important indicator in evaluating the severity and prognosis of critical patients.