代谢综合征对脓毒性休克患者T淋巴细胞亚群及预后的影响

Influence of metabolism syndrome on T lymphocyte subsets and prognosis in patients with septic shock

目的探讨代谢综合征（MS）对脓毒性休克患者外周血T淋巴细胞亚群及预后的影响。方法选取2014年1月至2017年6月海南医学院第二附属医院东湖分院急诊科收治的脓毒性休克患者93例作为研究对象，根据是否合并MS，将脓毒性休克患者分为非MS组（48例）和MS组（45例）。所有患者入院后均给予积极规范治疗。比较2组患者T淋巴细胞亚群相关指标和临床终点指标，采用Pearson相关性方法分析MS对脓毒性休克患者外周血T淋巴细胞亚群及预后的影响。结果MS组患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分明显高于非MS组[（23±5）分比（21±6）分]，差异有统计学意义（P〈0．05）。MS组患者co；T淋巴细胞、CD4T淋巴细胞及CD8T淋巴细胞水平明显低于非MS组[（50±6）％比（55±7）％、（36±6）％比（39±6）％、（18±5）％比（21±6）％]，差异均有统计学意义（均P〈0．05），而MS组患者CD4／CD8＋T淋巴细胞比值与非MS组比较，差异无统计学意义（P〉0．05）。MS组机械通气时间、血管活性药物使用时间及连续肾替代疗法时间长于日}MS组，28d病死率高于非MS组{（4．4±3．6）d比（2．94±2．8）d、（6．9±2．1）d比（5．9±1．7）d、（4．1±3．0）d比（2．8±2．7）d、37．8％（17／45）比16．7％（8／48）]，差异均有统计学意义（均P〈0．05）。MS组重症监护病房停留时间与非MS组比较，差异无统计学意义（P〉0．05）。Pearson相关性分析结果显示，脓毒性休克患者APACHE11评分与外周血CD4＋T淋巴细胞水平呈负相关（r=-0．256，P=0．013），而与其他T淋巴细胞亚群相关指标及临床终点无明显相关性（均P〉0．05）。结论MS可加重脓毒性休克患者T淋巴细胞亚群异常表达及病情，CD4T淋巴细胞与脓毒性休克患者病情严重程度密切相关。

Objective To investigate the influence of metabolism syndrome（MS） on T lymphocyte subsets and prognosis in patients with septic shock. Methods A total of 93 patients with septic shock admitted in Department of Emergency of Donghu Branch of the Second Affiliated Hospital of Hainan Medical University from January 2014 to June 2017 were divided into non-MS group（48 eases） and MS group（45 cases）. All patients had routine positive treatments for septic shock after admission. T lymphocyte subsets and clinical end-point indicators were recorded. Effect of MS on T lymphocyte subsets and prognosis in patients with septic shock was analyzed by Pearson test. Results Score of the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE H ） in MS group was significantly higher than that in non-MS group [ （23 ± 5 ）points vs （21± 6 ）points I （P 〈 0. 05 ）. Levels of CD3＋ /CD4＋ and CDs in MS group were significantly lower than those in non-MS group[ （50±6）% vs （55 ± 7）%, （36±6）% vs （39±6）%, （18 ±5）% vs （21±6）% 1 （P〈0.05）. The CD4/CDs ratio had no significant difference between groups （ P 〉 0. 05 ）. Mechanical ventilation time, vasoactive agent use time and continuous renal replacement therapy time in MS group were significantly longer than those in non-MS group; the 28 d fatality rate in MS group was significantly higher that in non-MS group [ （4.4±3.6） d vs （ 2. 9±2. 8 ） d, （ 6.9 ±2. 1 ） d vs （5.9 ±1.7）d, （4. 1±3.0）d vs （2. 8±2.7）d, 37.8% （17/45） vs 16. 7% （8/48） ] （P 〈0. 05）. Intensive Care Unit stay time had no significant difference between groups （ P 〉 0. 05 ）. Pearson correlation analysis showed that the APACHE II score was negatively correlated with the level of CD4 T lymphocyte（ r = - 0. 256, P = 0. 013 ）. Conclusion MS may aggravate abnormal expression of T lymphocyte subsets and severity of septic shock; CD4 T lymphocyte is closely related to the severity of septic shock.