淋巴细胞CD4^(+)与CD8^(+)比值、N末端脑钠肽前体及白细胞介素6对感染性休克病人预后评估的价值

Value of the lymphocyte CD4^(+)/CD8^(+)ratio,NT-proBNP and IL-6 in evaluating the prognosis of patients with septic shock

目的:探讨淋巴细胞CD4^(+)与CD8^(+)比值(CD4^(+)/CD8^(+))、N末端脑钠肽前体(NT-proBNP)及白细胞介素6(IL-6)对感染性休克病人预后评估的价值。方法:选取收治的感染性休克病人77例进行前瞻性研究,检测病人诊断感染性休克第一个24 h内的CD4^(+)/CD8^(+)、NT-proBNP及IL-6、最高乳酸(Lac)水平,并记录病人性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、是否合并基础病等资料。采用logistic回归分析感染性休克病人发生死亡的相关独立危险因素,将CD4^(+)/CD8^(+)、NT-proBNP及IL-6分别与APACHEⅡ评分进行直线相关回归分析;绘制受试者工作特(ROC)曲线分析CD4^(+)/CD8^(+)、NT-proBNP及IL-6对感染性休克病人预后评估的价值。结果:感染性休克死亡组NT-proBNP及IL-6水平明显高于存活组(P<0.05),CD4^(+)/CD8^(+)明显低于存活组;logistic回归分析显示年龄、APACHEⅡ评分、基础病、Lac、NT-proBNP及IL-6均为感染性休克病人死亡的独立危险因素,CD4^(+)/CD8^(+)是病人的保护因素;IL-6、NT-proBNP、与APACHEⅡ具有良好的相关性(P<0.01),CD4^(+)/CD8^(+)与APACHEⅡ未见明显相关性(P>0.05);ROC曲线显示第1天血清NT-proBNP、IL-6、血液CD4^(+)/CD8^(+)对感染性休克病人死亡的预测效能ROC曲线下面积分别为0.793、0.678、0.708(P<0.05);三项指标联合预测效能ROC曲线下面积为0.840(P<0.05)。结论:CD4^(+)/CD8^(+)、NT-proBNP及IL-6与感染性休克病人严重程度及预后明显相关,三项综合对脓毒症病人的预后具有较好的预测价值。

Objective:To investigate the value of the lymphocyte CD4^(+)/CD8^(+)ratio,N-terminal brain natriuretic peptide precursor(NT-probNP)and interleukin 6(IL-6)in evaluating the prognosis of patients with septic shock.Methods:Seventy-seven patients with septic shock were selected for prospective study,and the CD4^(+)/CD8^(+)ratio,NT-probNP,IL-6 and Maximun lactate(Lac)levels in all cases were detected in the first 24 h after septic shock.The gender,age,acute physiology and chronic health status scoring systemⅡ(APACHEⅡ)score,combined with underlying diseases and other data were recorded.The independent risk factors of death in septic shock patients were analyzed by logistic regression analysis,and the CD4^(+)/CD8^(+)ratio,NT-probNP and IL-6 were analyzed by linear correlation regression with APACHEⅡscore.The receiver operating characteristic(ROC)curve was drawn to analyze the value of CD4^(+)/CD8^(+)ratio,NT-probNP and IL-6 in the evaluation of prognosis of patients with septic shock.Results:The levels of NT-probNP and IL-6 in septic shock death group were significantly higher than those in survival group(P<0.05),and the CD4^(+)/CD8^(+)ratio in septic shock death group was significantly lower than that in survival group.The results of logistic regression analysis showed that the age,APACHEⅡscore,underlying disease,Lac,NT-probNP and IL-6 were the independent risk factors of death in patients with septic shock,and the CD4^(+)/CD8^(+)ratio was a protective factor.The IL-6 and NT-probNP had a good correlation with APACHEⅡ(P<0.01),while the CD4^(+)/CD8^(+)ratio had not significant correlation with APACHEⅡ(P>0.05).The ROC curve showed that the predictive efficacy of serum NT-probNP,IL-6 and blood CD4^(+)/CD8^(+)ratio on the death of septic shock patients on day 1 were 0.793,0.678 and 0.708,respectively(P<0.05).The area under ROC curve was 0.840(P<0.05).Conclusions:The CD4^(+)/CD8^(+)ratio,NT-proBNP and IL-6 are significantly correlated with the severity and prognosis of septic shock patients.The combination of these three factors has excellent predictive value for the prognosis of septic shock patients.