外周血CD8+CD28-CD57+T淋巴细胞对老年脓毒症患者预后的预测价值

Predictive analysis for prognosis of CD8+CD28-CD57+T lymphocyte in geriatric patients with sepsis

目的 探讨外周血CD8+CD28-CD57+T淋巴细胞对老年脓毒症患者预后的预测价值。方法 采用回顾性队列研究,选取2015年2月—2016年8月西安交通大学第二附属医院重症医学科住院的年龄≥60岁的脓毒症患者75例,依据ICU结局分为存活组(n=54)及死亡组(n=21)。收集患者一般资料,诊断脓毒症当天进行急性生理和慢性健康评分Ⅱ(APACHEⅡ)评分及序贯器官衰竭(SOFA)评分,检测外周血液标本TNF-a、IL-10及CD8+CD28-CD57+T淋巴细胞。结果 死亡组平均年龄大于存活组(P<0.05)。死亡组较存活组有更高的APACHEⅡ评分、SOFA评分及休克比例,差异均有统计学意义(P<0.05)。死亡组外周血CD8+CD28-CD57+T淋巴细胞、TNF-a、IL-10较存活组更高(P<0.05)。存活组的耐药菌感染比例低于死亡组,但差异无统计学意义(P>0.05)。无论单因素还是对一系列协变量进行调整的多因素Logistic回归分析均显示,较高的外周血CD8+CD28-CD57+T淋巴细胞比例与高的ICU死亡率相关(OR, 1.21;95%CI, 1.10~1.33)(OR, 1.30;95%CI, 1.07~1.58);APACHEⅡ评分预后预测的AUC为0.78(95%CI 0.67~0.90),将最适诊断界点22.5分作为预测死亡可能的临界点,敏感性和特异性分别为61.9%和75.2%。SOFA评分预后预测的AUC为0.80(95%CI,0.68~0.92),将最适诊断界点9.5分作为预测死亡可能的临界点,敏感性和特异性分别为71.4%和77.8%。外周血CD8+CD28-CD57+T淋巴细胞预后预测的AUC为0.91(95%CI,0.83~0.99),将最适诊断界点60.2%作为预测死亡可能的临界点,敏感性和特异性分别为81.0%和92.6%。结论 老年脓毒症患者外周血高CD8+CD28-CD57+T淋巴细胞比例与ICU死亡率增加相关,一定程度上可用于评估此类人群的病情严重程度及预测预后。

Objective To evaluate the prognostic roles of peripheral blood CD8+CD28-CD57+T lymphocyte ratio in geriatric patients with sepsis.Methods This is a retrospective cohort study.Clinical data of geriatric patients with sepsis(age≥60 years)admitted to intensive care unit(ICU)of Second Affiliated Hospital of Xi′an Jiao tong University from February 2015 to August 2016 were collected.APACHEⅡscore and SOFA score were performed on the day of diagnosis of sepsis,and peripheral blood samples were collected to detect the expressions of TNF-a、IL-10 and CD8+CD28-CD57+.Results A total of 75 sepsis patients aged≥60 years who met the admission and exclusion criteria were collected and divided into survival group(n=54)and death group(n=21)according to ICU outcome.Both univariate and multivariate logistic regression analyses adjusted for a series of covariates showed that higher percentages of peripheral blood CD8+CD28-CD57+T lymphocytes were associated with higher ICU mortality(OR,1.21;95%CI,1.10-1.33)(OR,1.30;95%CI,1.07-1.58);By ROC curve analysis for prognosis,the AUC of APACHE II score was 0.78(95%CI 0.67-0.90).The best cut-off was 22.5 with the sensitivity of 61.9%and specificity of 75.2%.The AUC of SOFA score was 0.80(95%CI 0.68-0.92).The best cut-off was 9.5 with the sensitivity of 71.4%and specificity of 77.8%.The AUC of peripheral blood CD8+CD28-CD57+T lymphocyte ratio was 0.91(95%CI 0.83-0.99).The best cut-off was 60.2%with the sensitivity of 81.0%and specificity of 92.6%.Conclusion The high percentage of CD8+CD28-CD57+T lymphocytes in peripheral blood of elderly patients with sepsis is associated with increased ICU mortality,which can be used to evaluate the severity of the disease and predict the prognosis in this population.