感染性休克患者凝血功能、炎性因子、细胞免疫功能与病情严重程度的相关性

The relationship between coagulation, inflammatory factors, cellular immune function and severity of septic shock

目的探讨感染性休克患者凝血功能、炎性因子和细胞免疫功能与病情严重程度的相关性。方法选择浙江省荣军医院2018年2月至2019年2月收治的感染性休克患者97例,按照患者入院后28 d预后情况分为生存组62例与病死组35例;另选择浙江省荣军医院2018年2月至2019年2月健康体检者50例为对照组。采用全自动血凝分析仪测定凝血功能指标变化;采用免疫比浊法测定C反应蛋白(CRP)水平,采用电化学发光法测定降钙素原(PCT)水平;采用流式细胞术测定T淋巴细胞亚群变化。结果生存组血浆纤维蛋白原(Fib)(3.54±0.25)g/L、D-二聚体(D-D)(3.42±1.08)mg/L,病死组血浆Fib(4.08±0.34)g/L、D-D(5.31±1.45)mg/L,均高于对照组的(3.17±0.38)g/L和(0.53±0.16)mg/L(F=6.893、13.245,均P<0.05),且生存组血浆Fib和D-D水平低于病死组(P<0.05)。生存组血清CRP(48.85±6.57)mg/L、PCT(4.35±1.28)g/L,病死组血清CRP(132.52±19.48)mg/L、PCT(10.48±1.96)g/L,均高于对照组的(2.76±0.63)mg/L和(0.10±0.03)g/L(F=48.973、13.241,均P<0.05),生存组血清CRP和PCT水平低于病死组(P<0.05)。生存组CD^+3(62.35±3.87)%、CD^+4(37.48±2.86)%、CD^+4/CD^+8(1.40±0.14),病死组CD^+3(54.61±3.46)%、CD^+4(33.09±2.15)%、CD^+4/CD^+8(1.07±0.20),均低于对照组的(75.34±4.35)%、(43.87±1.90)%和(1.89±0.16)(F=6.893、13.245,均P<0.05),生存组CD^+3、CD^+4和CD^+4/CD^+8高于病死组(P<0.05)。生存组急性生理学及慢性健康状态评分Ⅱ(APACHEⅡ)评分(9.28±1.35)分,低于病死组的(15.64±2.48)分(t=16.383,P<0.05)。结论感染性休克患者存在凝血功能异常,明显炎性反应及免疫功能下降,且凝血功能、炎性因子和细胞免疫功能与病情严重程度具有明显相关性。

Objective To investigate the relationship between the coagulation function,inflammatory factors,cellular immune function and the severity of septic shock.Methods From February 2018 to February 2019,97 patients with septic shock admitted to Zhejiang Rongjun Hospital were divided into survival group(62 cases)and death group(35 cases)according to the prognosis of patients at 28 days after admission.Another 50 healthy physical examinees in Zhejiang Rongjun Hospital from February 2018 to February 2019 were selected as the control group.The changes of coagulation function were measured by automatic hemagglutination analyzer.C-reactive protein(CRP)and procalcitonin(PCT)were detected by electrochemiluminescence,and T-lymphocyte subsets were determined by flow cytometry.Results The fibrinogen(Fib)and D-dimer(D-D)levels in the survival group[(3.54±0.25)g/L,(3.42±1.08)mg/L]and death group[(4.08±0.34)g/L and(5.31±1.45)mg/L]were higher than those in the control group[(3.17±0.38)g/L and(0.53±0.16)mg/L](F=6.893,13.245,all P<0.05).The levels of Fib and D-D in the survival group were lower than those in the death group(P<0.05).The serum levels of CRP and PCT in the survival group[(48.85±6.57)g/L,(4.35±1.28)mg/L]and death group[(132.52±19.48)mg/L,(10.48±1.96)g/L]were higher than those in the control group[(2.76±0.63)mg/L,(0.10±0.03)g/L](F=48.973,13.241,all P<0.05).The levels of CRP and PCT in the survival group were lower than those in the death group(all P<0.05).The CD^+3,CD^+4and CD^+4/CD^+8in the survival group[(62.35±3.87)%,(37.48±2.86)%,(1.40±0.14)]and death group[(54.61±3.46)%,(33.09±2.15)%,(1.07±0.20)]were lower than those in the control group[(75.34±4.35)%,(43.87±1.90)%and(1.89±0.16)](F=6.893,13.245,all P<0.05).The CD^+3,CD^+4and CD^+4/CD^+8in the survival group were higher than those in the death group(P<0.05).The APACHEⅡscore[(9.28±1.35)points]of the survival group was lower than that of the death group[(15.64±2.48)points](t=16.383,P<0.05).Conclusion The patients with septic shock have abnormal coagulation function,obvious inflammatory reaction and decreased immune function,and the coagulation function,inflammatory factors and cellular immune function are significantly related to the severity of the disease.