淋巴细胞亚群联合检测对脓毒症患者不良预后的评估价值

Value of lymphocyte subgroups jointly detected in assessing poor prognosis of patients with sepsis

目的 探讨T、B和NK淋巴细胞亚群相关指标对脓毒症患者不良预后的预测价值.方法 应用前瞻性研究方法,选取宁夏人民医院急诊重症监护室（EICU）及ICU共101例脓毒症患者为对象,检测入院48 h内外周血T、B和NK淋巴细胞亚群相关指标水平,随访至出院,观察指标异常对死亡结局的危险度,评估各指标联合检测对死亡风险的预测价值.结果 脓毒性休克患者CD3、CD3 ＋/CD4＋低于脓毒症组和严重脓毒症组,严重脓毒症和脓毒性休克患者CD3 ＋/CD8＋,CD3-/CD19＋,CD4 ＋/CD8＋低于脓毒症组,CD （16＋56）＋高于脓毒症组（P＜0.05）;死亡患者的单核细胞高于生存患者,CD3、CD3-/CD19＋、CD3 ＋/CD4＋、CD4 ＋/CD8＋低于生存患者（P＜0.05）; CD3-/CD19＋、CD3 ＋/CD8、CD4 ＋/CD8＋为脓毒症预后的保护因素,OR值分别0.235、0.006、0.108;淋巴细胞亚群联合预测因子、APACHEⅡ评分、SOFA评分对死亡风险预测效能的ROC曲线下面积分别为0.993、0.877、0.848;淋巴细胞亚群联合判别函数对病情程度的误判率为19.8％,对患者结局的误判率为4％.结论 脓毒症患者淋巴细胞亚群表达异常,淋巴细胞亚群的联合检测对脓毒症患者的病情及预后有指导价值.

Objective To investigate the predictive value of T,B,and NK lymphocyte subsets jointly detected in poor prognosis in patients with sepsis.Methods Totally 101 patients with sepsis were enrolled for prospective study.The percentages of lymphocyte sub-populations in peripheral blood were detected within 48 h after admission.The outcomes of patients during hospitalization were observed by follow-up study.The predictive value of lymphocyte sub-populations jointly detected in death risk was assessed.Results The percentages of CD3,CD3 ＋/CD4 ＋ in patients with septic shock were lower than those in patients with mild/moderate sepsis and severe sepsis.The percentages of CD3＋/CD8＋,CD3-/CD19 ＋,CD4 ＋/CD8 ＋ in patients with severe sepsis and septic shock were lower than those in patients with mild/moderate sepsis.The percentage of CD （16 ＋56） ＋ in severe sepsis and septic shock was higher than that in mild/moderate sepsis group （P ＜ 0.05）.The total number of monocytes in the deaths was higher than that in survivals.The percentages of CD3,CD3-/CD19 ＋,CD3 ＋/CD4 ＋,CD4 ＋/CD8 ＋ were lower in deaths than those in survivals （P ＜ 0.05）.The CD3-/CD19 ＋,CD3 ＋/CD8 and CD4 ＋ / CD8 ＋ were protective factors against sepsis with their OR values of 0.235,0.006 and 0.108,respectively.The ROC curve of lymphocyte subsets jointly detected,APACHE]] score and SOFA score to predict the risk of death were 0.993,0.877 and 0.848,respectively.The misjudgment rate of discriminating disease severity function of lymphocyte subgroups jointly detected was 19.8％,and that of outcomes was 4％.Conclusion The percentages of lymphocyte sub-populations in patients with sepsis is abnormal,and therefore,the lymphocyte subgroups jointly detected has value in the judgment of disease severity and prognosis in patients with sepsis.