不同预后脓毒症患者血小板活化程度及T细胞功能水平的差异性分析

Differences of platelet activation and T cell function in patients with sepsis with different prognosis

目的:探讨不同预后脓毒症患者血小板活化程度及T细胞功能水平的差异性及与预后不良风险的相关性。方法:回顾性分析2020年1月—2023年2月就诊于新疆医科大学第七附属医院的89例脓毒症患者。根据患者住院期间感染是否得到控制、出院后3个月内预后情况划分为预后良好组(61例)和预后不良组(28例)。对比两组患者性别、年龄、快速序贯器官衰竭估计评分等一般临床资料;血小板因子4(platelet factor 4,PF4)、P-选择素及蛋白激酶Cδ等血小板活化相关血清学标志物;CD62p、CD40L及CD63等血小板活化相关膜表面标志物;CD4^(+)T细胞比例、CD8^(+)T细胞比例及CD4^(+)T/CD8^(+)T比值等T细胞功能相关指标。分析不同预后患者间各指标的差异,通过Spearman相关性分析及多因素logistic回归分析筛选脓毒症患者预后不良的危险因素。结果:预后不良组患者的血清PF4、P-选择素水平、血小板CD62p、CD40L及CD63阳性率均显著高于预后良好组患者,差异有统计学意义(P<0.05);预后不良组患者的CD4^(+)T细胞比例、CD4^(+)/CD8^(+)比值显著低于预后良好组患者,差异有统计学意义(P<0.05);脓毒症患者预后不良与患者血清PF4、P-选择素水平、血小板CD62p、CD40L及CD63阳性率呈显著正相关,与CD4^(+)T细胞比例及CD4^(+)/CD8^(+)比值呈显著负相关,差异有统计学意义(P<0.05);脓毒症患者血小板CD62p及CD63阳性率增加,CD4^(+)T细胞比例及CD4^(+)/CD8^(+)比值降低均是预后不良的危险因素,差异有统计学意义(P<0.05)。结论:不同预后情况的脓毒症患者血小板活化程度及T细胞功能存在较大差异,其中CD62p及CD63等血小板活化相关膜指标阳性率增加、CD4^(+)T细胞比例及CD4^(+)/CD8^(+)比值等T细胞功能指标降低可能提示脓毒症患者预后不良,监测相关指标将有利于早期评估脓毒症患者病情及预后情况。

Objective To investigate the difference of platelet activation and T cell function in patients with sepsis with different prognosis and the correlation with the risk of poor prognosis.Methods Eighty-nine patients with sepsis from January 2020 to February 2023 were analyzed.According to whether the infection was controlled during hospitalization and the prognosis within 3 months after discharge,the patients were divided into two groups:good prognosis group(n=61)and poor prognosis group(n=28).The general clinical data such as sex,age,quick sequential organ failure assessment,platelet activation related serological markers such as platelet factor 4(PF4),P-selectin and protein kinase Cδ,platelet activation related membrane markers such as CD62p,CD40L and CD63,and T cell function related indexes such as CD4^(+)T cell proportion,CD8^(+)T cell proportion and CD4^(+)T/CD8^(+)T ratio were compared between the two groups.The differences of various indexes among patients with different prognosis were analyzed,and the risk factors of poor prognosis in patients with sepsis were screened by Spearman correlation analysis and multivariate logistic regression analysis.Results The levels of serum PF4,P-selectin,platelet CD62p,CD40L and CD63 in patients with poor prognosis were significantly higher than patients with good prognosis(P<0.05).The proportion of CD4^(+)T cells and CD4^(+)/CD8^(+)ratio in patients with poor prognosis were significantly lower than patients with good prognosis(P<0.05).The poor prognosis of patients with sepsis was positively correlated with the levels of serum PF4,P-selectin,platelet CD62p,CD40L and CD63,and negatively correlated with the proportion of CD4^(+)T cells and the ratio of CD4^(+)/CD8^(+)(P<0.05).The increase of platelet CD62p and CD63 positive rate and the decrease of CD4^(+)T cell proportion and CD4^(+)/CD8^(+)ratio were risk factors for poor prognosis in patients with sepsis(P<0.05).Conclusion There are significant differences in platelet activation and T cell function in patients with sepsis with different prognosis.The increase in the positive rate of platelet activation related membrane indexes such as CD62p and CD63 and the decrease of T cell function indexes such as CD4^(+)T cell proportion and CD4^(+)/CD8^(+)ratio may indicate a poor prognosis of septic patients.Monitoring related indexes will be helpful to early evaluate the condition and prognosis of septic patients.