干扰素-γ、CD47和淋巴细胞亚群在脓毒症患者中的表达及其与预后的关系

Expression of interferon-γ,CD47 and lymphocyte subsets in patients with sepsis and their relationships with prognosis

目的探讨脓毒症患者血清干扰素-γ(IFN-γ)、CD47和淋巴细胞亚群水平及其与预后的关系。方法选取180例脓毒症患者为观察组,选择同期180例健康体检志愿者为对照组。根据患者入院28 d的生存情况,将患者分为生存组120例和死亡组60例。采用酶联免疫吸附法(ELISA)检测脓毒症患者血清IFN-γ、CD47水平,流式细胞术检测血清淋巴细胞亚群水平,并对影响脓毒症患者的预后因素进行Logistic回归分析。采用受试者工作特征(ROC)曲线分析血清IFN-γ、CD47、淋巴细胞亚群水平预测脓毒症患者预后的价值。结果与对照组比较,观察组血清IFN-γ、T淋巴细胞、B淋巴细胞、自然杀伤细胞水平降低,CD47水平升高,差异有统计学意义(P<0.05)。与生存组比较,死亡组血清IFN-γ、T淋巴细胞、B淋巴细胞、自然杀伤细胞水平降低,急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、C反应蛋白、降钙素原、内毒素、CD47水平升高,差异有统计学意义(P<0.05)。SOFA评分与血清IFN-γ、T淋巴细胞、B淋巴细胞、自然杀伤细胞水平呈负相关(r=-0.469、-0.572、-0.521、-0.505,P<0.05),与血清CD47水平呈正相关(r=0.539,P<0.05)。APACHEⅡ评分、SOFA评分、C反应蛋白、降钙素原、内毒素和CD47水平升高是脓毒症患者预后的危险因素,IFN-γ水平、T淋巴细胞、B淋巴细胞和自然杀伤细胞增高是患者预后的保护因素(P<0.05)。IFN-γ、CD47、T淋巴细胞、B淋巴细胞、自然杀伤细胞单独检测和联合检测预测脓毒症患者预后的曲线下面积(AUC)分别为0.805、0.808、0.888、0.846、0.854、0.984,联合检测的AUC优于单独检测(P<0.001)。结论脓毒症患者血清IFN-γ、T淋巴细胞、B淋巴细胞、自然杀伤细胞水平降低,CD47水平升高,其水平变化对预测脓毒症患者的预后具有一定价值。

Objective To investigate the levels of serum interferon-γ(IFN-γ),CD47 and lymphocyte subsets in patients with sepsis and their relationships with prognosis.Methods A total of 180 patients with sepsis who were treated in our hospital were selected as observation group,and 180 healthy volunteers in the same period as control group.Based on the survival status of patients within 28 days of hospitalization,the patients were divided into survival group of 120 cases and death group of 60 cases.The levels of serum IFN-γand CD47 in patients with sepsis were detected by enzyme-linked immunosorbent assay(ELISA);the level of serum lymphocyte subsets was detected by flow cytometry.Logistic regression analysis was performed on the factors affecting the prognosis of patients with sepsis;the clinical value of the levels of serum IFN-γ,CD47 and lymphocyte subsets in predicting the prognosis of patients with sepsis was analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of serum IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells in the observation group were decreased,while the level of CD47 was increased(P<0.05).In the death group,the levels of serum IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells were also decreased,while the acute physiology and chronic health evaluation-Ⅱ(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA)score,C-reactive protein,procalcitonin,endotoxin,and CD47 levels were increased compared with the death group(P<0.05).The SOFA score was negatively correlated with the levels of serum IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells(r=-0.469,-0.572,-0.521,-0.505,P<0.05),but positively correlated with the serum CD47 level(r=0.539,P<0.05).Elevated levels of APACHEⅡscore,SOFA score,C-reactive protein,procalcitonin,endotoxin,and CD47 were risk factors for the prognosis of patients with sepsis,while increased levels of IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells were protective factors for the prognosis(P<0.05).The areas under the curve(AUC)for predicting the prognosis of sepsis patients using IFN-γ,CD47,T lymphocytes,B lymphocytes,and natural killer cells alone and their combination were 0.805,0.808,0.888,0.846,0.854,and 0.984,respectively,and the AUC of the combined detection was superior to that of the individual detection(P<0.001).Conclusion The levels of serum IFN-γ,T lymphocytes,B lymphocytes and natural killer cells in patients with sepsis are decreased,and the level of CD47 is increased,which is related to the prognosis of patients with sepsis and has certain predictive value for the prognosis of patients with sepsis.