脓毒症患者T细胞亚群的变化及临床意义

Changes and clinical significance of T lymphocyte subsets in patients with sepsis

目的观察脓毒症及严重患者T细胞亚群变化及意义。方法回顾分析2012年7月-2013年7月广东韶关粤北人民医院重症医学科(ICU)收治的脓毒症和严重脓毒症的70例患者的临床资料,其中脓毒症组40例,严重脓毒症组30例,存活56例,死亡14例。入院时流式细胞仪检测外周血CD4+T细胞、CD8+T细胞和CD4+T/CD8+T比值,计算急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。根据患者诊断和预后分组,比较各指标,并采用Pearson相关分析评价T细胞亚群的相关性。结果重症脓毒症患者CD8+T细胞(31.9±5.1)%低于脓毒症患者(34.4±4.6)%,CD4+T细胞(22.8±4.9)%明显低于脓毒症患者(31.1±2.9)%,CD4+/CD8+T细胞比值(0.6±0.6)也明显低于脓毒症患者(1.1±0.4),重症脓毒症患者APACHEⅡ(25.01±9.97)比脓毒症患者(18.35±6.22)明显升高。与存活组CD4+T细胞、CD4+T/CD8+T细胞比值(28.2±4.8、1.5±0.8)%相比,死亡组(14.5±6.0、0.8±0.7)%明显降低,死亡组较存活组APACHEⅡ(26.99±8.01、10.36±6.77)评分明显升高,CD4+T细胞、CD4+T/CD8+T细胞比值与APACHEⅡ评分负相关(r=-0.58,r=-0.42,P<0.05)。结论 CD4+T细胞、CD4+T/CD8+T细胞比值与脓毒症的严重程度及预后相关,可作为脓毒症患者病情评估及治疗效果的辅助指标之一。

[ Objective ] To observe the changes in subgroups of T cells and serum proealeitonin （PCT） levels in patients with sepsis and severe sepsis. [ Methods ] Clinical data of 70 patients admitted to intensive care unit（ICU） of GuangDong YueBei People Hospital from July 2012 to September 2013 were retrospectively analyzed.Among these patients, there were 40 with sepsis and 30 with severe sepsis.14 of them died.And 56 survived. Control percentage of CD4＋, CD8＋T cells and CD4＋/CD8＋ ratio were determined at admission. Acute physiology and chronic health evaluation Ⅱ （APACHEⅡ ）was estimated.The patients were divided into different groups according to diagnosis and prognosis to compare the value of the indexes. The correlation between subgroup of T lymphocyte and o APACHE Ⅱ were analyzed by Pearson relative analysis. [ Results ] Compared with sepsis group（31.1 ± 2.9%,1.1 ± 0.4）%,The percentage of CD4＋T cells （22.8 ± 4.9%）and CD4＋/ CD8＋ ratio （0.6± 0.6）% were significantly lower, APACHE Ⅱ scores（25.01± 9.9）significantly higher in severe sepsis group. The percentage of CD4 ＋ T cells （14.5± 6.0）% and CD4＋/CD8＋ ratio（0.8 ± 0.7）% in the death group were lower than those in the survival group（28.2± 4.8%, 1.5 ±0.8%）, APACHE Ⅱ scores in the death group were obviously lower than those in the survival group（26.99± 8.01, 10.36± 6.77）, the percentage of CD4＋T cells and CD4＋/CD8＋ ratio were negatively correlated with APACHE Ⅱ scores（r=-0.58, r=-0.42, P〈0.05）. [ Conclusion ] The percentage of CD4＋T cells and CD4＋/CD8＋ ratio are related with the severity of sepsis, and the percentage of CD4＋T cells and CD4＋/CD8＋ ratio may be an indicator for evaluating the illness and prognosis.