老年手术风险评分与外周血T细胞亚群变化及手术并发症的相关性研究

Correlation of surgical risk score with change of T cell subsets and occurrence of postoperative complications in the elderly patients

目的探讨骨科老年患者手术风险评分与T细胞亚群的变化及手术后并发症的相关性。方法将研究对象根据老年手术风险评分分为高风险组（A组）和低风险组（B组），分别在患者术前1d、术后1，3，5，7，14d清晨取空腹外周静脉血，检测T细胞亚群（CD3、CIM、CD8）变化，观察风险评分与外周血T细胞亚群及术后并发症之间是否存在相关性。结果B组出现并发症2例（肺部感染），无死亡；A组出现1例死亡、5例并发症（肺部感染2例、切口感染1例、深静脉血栓2例）。A、B两组CD3、CD4值在术后1，3d均明显低于术前对照组（P〈0．01），尤其术后第1天降低最明显，术后第5天逐渐回升。A组于术后第7天恢复接近正常，14d恢复正常，而B组14d时仍明显低于术前水平；A组CD8在术后1，5d下降，随后升高并维持相对稳定，B组反而增高。两组T淋巴细胞亚群在手术创伤后1～7d有由低至高向正常恢复的趋势，术前评分越高，下降越明显，恢复越慢。结论手术风险评分与T细胞亚群的变化及术后并发症存在正相关，两者均可用来预测老年患者手术的预后。

Objective To discuss the correlation of the surgical risk score with the change of T cell subsets and the occurrence of postoperative complications. Methods A total of 260 patients with hip fractures treated in our department were enrolled in this study and divided into high-risk group （ Group A） and low-risk group （Group B） based on the surgical risk score. The fasting peripheral venous blood was taken in the morning at one day before surgery and at days 1, 3, 5, 7 and 14 after surgery for measuring CD3, CD4 and CD8 levels respectively in two groups. In the meantime, the correlation of level changes with risk score and postoperative complications was observed in two groups. Results There were two patients with lung infection in the Group B, with no death. There were two patients with pulmonary infection, one with wound infection and two with deep vein thrombosis, with one death. The postoperative levels of CD3 and CD4 in the Group A and Group B were significantly lower than those in the control group （ P 〈 0.01 ） , which reached the lowest level at day 1 after operation and recovered to normal at day 5 after operation. The postoperative levels of CD3 and CD4 in the Group A recovered near to normal at day 7 and to normal at day 14. While the postoperative levels of CD3 and CD4 in the Group B remained low level even at day 14. The level of CD8 decreased at days 1 and 5 in the Croup A, then increased and remained relatively stable, while the level of CD8 increased in the Croup B. The T cell subsets in both groups recovered from low to high trend at days 1-7 after surgery. The higher preoperative score had more obvious decrease and slower recovery of the T cell subsets. Conclusions Surgical risk score has positive correlation with the change of T cell subsets and postoperative complications, which can more accurately predict the postoperative outcome of the old patients.