淋巴细胞亚群预测脓毒性休克患者预后的价值

Prognostic value of lymphocyte subsets in patients with septic shock

目的:观察脓毒性休克患者外周血淋巴细胞亚群变化与预后的关系,探讨外周血淋巴细胞亚群预测脓毒性休克预后的临床价值。方法:回顾性分析2018年8月1日~2020年7月31日在弋矶山医院重症医学科收治的脓毒性休克患者50例。根据确诊脓毒性休克后30 d内患者的预后情况将患者分为两组:死亡组(n=21)和生存组(n=29)。记录脓毒性休克患者确诊当日的年龄、性别、心率、体温、白细胞计数等临床资料及外周血淋巴细胞亚群。根据当天淋巴细胞总数计算CD4+、CD8+、CD16+56+、CD19+的淋巴细胞数。结果:两组患者性别、年龄、体温、降钙素原(PCT)、C反应蛋白、白细胞、ICU住院时间差异均无统计学意义(P>0.05)。死亡组患者CD4+T淋巴细胞数以及CD4+T/CD8+T淋巴细胞比值低于存活组,差异有统计学意义(P<0.05)。CD8+T淋巴细胞数、CD16+56+、CD19+淋巴细胞数两组间差异无统计学意义(P>0.05)。死亡组患者心率、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分高于存活组,差异有统计学意义(P<0.05)。结论:脓毒性休克患者血CD4+T淋巴细胞数、CD4+T/CD8+T淋巴细胞比值对早期判断患者预后有指导意义。

Objective:To assess the clinical value of changes of peripheral blood lymphocyte subsets in predicting the prognosis in patients with septic shock.Methods:Retrospective analysis was performed in 50 cases of septic shock treated in the ICU of our hospital between August 1,2018 and July 31,2020.All cases were divided into detath group(n=21)and survival group(n=29)according to the prognosis within 30 days after diagnosis.The baseline data,including patient′s age,gender,heart rate,body temperature,leukocyte count and levels of peripheral blood lymphocyte subsets at the day of diagnosis,were maintained.The number of CD4+,CD8+,CD16+56+and CD19+lymphocyte was calculated according to the total count of lymphocytes measured at the day of diagnosis.Results:There were no significant differences in gender,age,body temperature,procalcitonin(PCT),C-reactive protein,white blood cell count and length of stay in ICU between the two groups(P>0.05).The cell count of CD4+T lymphocyte and the ratio of CD4+T/CD8+T lymphocyte cells in the death group were significantly lower than those in the survival group(P<0.05),yet the ratio of CD8+T,CD16+56+and CD19+lymphocytes showed no significant difference between groups(P>0.05).Patients in the death group had significantly higher heart rate and APACHEⅡscore than those in the survival group(P<0.05).Conclusion:CD4+T lymphocytes and CD4+T/CD8+T lymphocyte cell ratio in peripheral blood can be valuable in early predicting the prognosis of patients with septic shock.