T淋巴细胞亚群、超敏肌钙蛋白T及APACHEⅡ对血液灌流联合血液滤过治疗ICU重症脓毒症预后的价值研究

Correlation between T lymphocyte subsets,hypersensitive troponin T,APACHEⅡ and hemoperfusion combined with hemofiltration in the treatment of ICU severe sepsis

目的分析T淋巴细胞亚群、超敏肌钙蛋白T(hs-TnT)及APACHEⅡ评分与血液灌流联合血液滤过治疗ICU重症脓毒症预后的相关性。方法收集该院重症监护室(ICU)接受血液灌流联合血液滤过治疗的重症脓毒症患者100例,于患者入院后48h内及治疗后第5天,分别检测患者的外周血T淋巴细胞亚群的相关指标、hs-TnT及APACHEⅡ评分,随访至出院,观察上述指标治疗前后的变化,并评估检测各指标对患者预后即死亡风险的预测价值。结果 Logistic回归分析发现,CD3^+、CD4^+、CD4^+/CD8^+、hs-TnT及APACHEⅡ评分均与患者预后相关,OR值分别为2.637、2.589、2.451、-2.673和-2.664,其中CD3^+、CD4^+、CD4^+/CD8^+与患者的存活呈正相关,而hs-TnT、APACHEⅡ评分与患者的存活呈负相关。结论 T淋巴细胞亚群、hs-TnT及APACHEⅡ评分与血液灌流联合血液滤过治疗ICU重症脓毒症患者的预后相关,联合检测上述指标对评估脓毒症患者的病情及预后有较好的临床应用价值。

Objective To analyze the correlation between T lymphocyte subsets,hypersensitivity troponin T and APACHEⅡcombined with hemoperfusion combined with hemofiltration in the treatment of ICU severe sepsis.Methods 100 patients with severe sepsis who received blood perfusion combined with hemofiltration in the intensive care unit（ICU）in the hospital were enrolled in the study.The related indexes of peripheral blood T lymphocyte subsets,hs-TnT and APACHE II score were measured within 48 hours after admission and the fifth day after the treatment.Follow-up was conducted till the discharge.The changes of the above indexes before and after treatment were observed,and the predictive value of each index for the prognosis of patients,namely the risk of death,was evaluated.Results Logistic regression analysis showed that CD3^＋,CD4^＋,CD4^＋/CD8^＋,hs-TnT and APACHEⅡ score were correlated with the prognosis of patients（OR=2.637,2.589,2.451,-2.673,-2.664）,and CD3^＋,CD4^＋,CD4^＋/CD8^＋were positively correlated with survival of the patients,while hs-TnT and APACHE II were negatively correlated with survival.Conclusion The T lymphocyte subsets,hs-TnT and APACHE II scores are related to the prognosis of hemofiltration combined with hemofiltration in the treatment of ICU patients with severe sepsis.The combined detection of these indicators has a good clinical value for assessing the condition and prognosis of patients with sepsis.