尿源性脓毒血症早期淋巴细胞亚群以及相关指标改变的临床研究

Clinical study on early changes of T-lymphocyte subset and related indicators in patients with urosepsis

目的:研究尿源性脓毒血症早期淋巴细胞亚群计数以及相关指标改变,希望为临床提高尿源性脓毒血症的早期诊断提供依据。方法:纳入2016-03-2017-04在我科住院的31例尿源性脓毒血症患者作为尿脓毒血症组,29例全身炎症反应综合征(SIRS)患者作为SIRS组,35例健康人作为对照组。对3组第一时间血象、降钙素原、淋巴细胞亚群、凝血酶时间以及相关评分等进行测定和比较,全部病例于入院治疗后、使用抗菌药物前的24h内测定。结果:CD4、降钙素原、CD3、淋巴细胞在诊断尿源性脓毒血症的效能方面相似,其中敏感度最高的为CD3(截断值728,敏感度69.0%);特异性最高的为降钙素原(截断值2.54,特异性82.8%);最优诊断是CD3&CD4,敏感性和特异性分别为71.0%和72.4%。SIRS组和尿脓毒血症组与APACHEⅡ评分均有相关性的是CD比值、红细胞、凝血酶原时间、国际标准化比值。结论:淋巴细胞亚群计数对于尿源性脓毒血症的诊断敏感性和特异性明显高于降钙素原,同时发现淋巴细胞亚群计数和红细胞计数在间接反映尿源性脓毒血症严重程度方面具有一定的临床作用。

Objective：To investigate the early changes of T-lymphocyte subset and related indicators in patients with urosepsis which can improve diagnosis of urosepsis.Method：From Mar 2016 to Apr 2017,a total of 31 hospitalized patients diagnosed as urosepsis were in urosepsis group.29 hospitalized patients diagnosed as SIRS were in SIRS group.And 35 healthy people were in control group.All patients were determined the levels of serum lymphocyte subsets,PCT,hemogram,thrombin and correlative evaluation before treating and using antibiotics within24 h.Result：The diagnostic value of serum CD4,CD3,PCT and lymphocyte applied in patients with urosepsis is similarity.Whereby the highest sensitivity and specificity indicators were CD3（728,69.0%）and PCT（2.54,82.2%）,but CD3 CD4 can achieved the best sensitivity（71.0%）and specificity（72.4%）.CD4/CD8,red blood cell count,PT and INR were positively correlated with APACHEⅡ score.Conclusion：The diagnostic value of Tlymphocyte subset in patients with urosepsis is better than PCT.Furthermore,T-lymphocyte subset and red blood cell count can reflect the severity of urosepsis.