外周血Treg、Th17、血乳酸、NLR值的变化与脓毒症患儿预后的关系

Correlation between changes of peripheral blood Treg, Th17, blood lactate, NLR and prognosis of children

目的分析脓毒症患儿外周血中调节性T细胞(Treg)、辅助性T细胞17(Th17)、血乳酸及中性粒细胞与淋巴细胞比值(NLR)的变化,及其与患儿预后的关系。方法选取郑州儿童医院2016年1月-2017年10月收治的120例脓毒症患儿作为研究组、60例健康儿童作为对照组。并对脓毒症患儿进行小儿死亡危险因素(PRISMⅢ)及小儿危重病例(PCIS)评分,比较两组及脓毒症不同预后患儿外周血Treg、Th17、血乳酸及NLR水平差异;分析脓毒症患儿外周血Treg、Th17、血乳酸、NLR水平与PRISMⅢ评分及PCIS评分的相关性。结果研究组患儿外周血Treg、Th17、血乳酸、NLR水平均高于对照组(P<0.05);死亡组患儿的外周血Treg、Th17、血乳酸、NLR检测值均高于存活组(P<0.05);死亡组患儿PRISMⅢ评分高于存活组,PCIS评分低于存活组(P<0.05);Pearson线性分析结果,脓毒症患儿PRISMⅢ评分与Treg、Th17、血乳酸、NLR指标呈正相关关系(P<0.05),PCIS评分与上述指标呈负相关关系(P<0.05)。结论脓毒症患儿外周血Treg、Th17、血乳酸、NLR升高,并且与患儿病情及预后结局有关。

OBJECTIVE To investigate the changes of peripheral blood regulatory T cells(Treg), helper T cells(Th17), serum lactate and neutrophils to lymphocyte ration(NLR) of the children with sepsis and observe their association with prognosis of the children. METHODS Totally 120 children with sepsis who were treated in Chidren′s Hospital Affiliated to Zhengzhou University from Jan 2016 to Oct 2017 were assigned as the study group, 60 healthy children were chosen as the control group.PRISM Ⅲ scores and PCIS of the children with sepsis were assessed, the levels of peripheral blood Treg, Th17, serum lactate and NLR were compared between the two group and among the children with different prognosis.The correlation between the peripheral blood Treg, Th17, serum lactate, NLR and the PRISM Ⅲ scores and PCIS was observed. RESULTS The levels of peripheral blood Treg, Th17, serum lactate and NLR of the study group were significantly higher than those of the control group(P<0.05);the levels of peripheral blood Treg, Th17, serum lactate and NLR of the death group were significantly higher than those of the survival group(P<0.05).The PRISM Ⅲ score of the death group was significantly higher than that of the survival group, the PCIS score of the death group was significantly lower than that of the survival group(P<0.05).The result of Pearson linear analysis showed that the PRISM score was positively correlated with the Treg, Th17, serum lactate and NLR(P<0.05), and the PCIS score was negatively correlated with the above indexes(P<0.05). CONCLUSION The levels of peripheral blood Treg, Th17, serum lactate and NLR of the pneumonia children complicated with sepsis are elevated, which is associated with the illness condition and prognosis.