摘要
目的探讨T淋巴细胞亚群联合降钙素原(PCT)、C反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)、白细胞计数(WBC)对脓毒症的辅助诊断及预后评估的应用价值。方法采用回顾性研究,选取2018年6月至2021年4月天津市第一中心医院诊治的72例脓毒症患者作为研究对象,纳入脓毒症组,其中男46例,女26例,年龄68(57.3,80.3)岁。另外选择同期收治的111例局部感染患者纳入局部感染组,其中男62例,女49例,年龄68(51,77)岁。脓毒症患者按照28 d转归分为生存组(43例)、死亡组(29例)两个亚组。采用流式细胞方法检测患者入院24 h内的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比值,酶联免疫荧光法检测PCT、免疫比浊法检测CRP、仪器法检测血常规、血乳酸(Lac)和氧分压(PO2)。应用多因素logistic回归分析评价各指标与脓毒症的关联,绘制受试者工作特征曲线(ROC)以评价各指标对脓毒症的诊断价值;应用多因素logistic回归分析及Kaplan-Meier生存分析评价各指标对脓毒症患者预后的预测价值。结果与局部感染组相比,脓毒症组外周血CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比值及PLT水平显著降低(Z=-8.184,P<0.001;Z=-7.210,P<0.001;Z=-5.936,P<0.001;Z=-2.700,P=0.007;Z=-6.381,P<0.001),PCT、CRP、NLR、Lac水平显著升高,差异有统计学意义(Z=-8.262,P<0.001;Z=-3.094,P=0.002;Z=-9.004,P<0.001;Z=-4.770,P<0.001);多因素logistic回归模型显示PCT、NLR、CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)为脓毒症的独立危险因素,经ROC曲线分析,各指标单独诊断脓毒症患者的AUC分别为0.862、0.894、0.858、0.760、0.618,临界值(cut-off值)分别为3.075 ng/ml、10.715、44.935×109个/L、27.463×109个/L、0.750时约登指数最大,其中NLR敏感度为80.6%,CD3^(+)特异度为94.6%;PCT、NLR两项指标联合检测AUC为0.947,敏感度为87.5%,特异度为91.9%;PCT、NLR、CD3^(+)、CD4^(+)/CD8^(+)四项指标联合检测AUC为0.958,敏感度为90.3%,特异度为91.0%(P<0.001);死亡组脓毒症患者PCT、Lac显著高于生存组(Z=-2.302,P=0.021;Z=-3.095,P=0.002);外周血CD4^(+)/CD8^(+)水平显著低于生存组(Z=-3.691,P<0.001);多因素logistic回归模型显示CD4^(+)/CD8^(+)比值是影响脓毒症患者28 d病死率的独立危险因素(P<0.001),ROC曲线示其AUC为0.758,cut-off值为1.27时约登指数最大,敏感度、特异度分别为79.3%、60.5%;相较于CD4^(+)/CD8^(+)≥1.27,CD4^(+)/CD8^(+)<1.27的脓毒症患者28 d病死率显著增加(P=0.032)。结论PCT、NLR、CD3^(+)、CD4^(+)/CD8^(+)四项指标联合检测可提高对脓毒症的辅助诊断效能,外周血CD4^(+)/CD8^(+)比值对脓毒症的预后可能有一定的预测价值。
Objective To explore the application value of T lymphocyte subsets combined with procalcitonin(PCT),C-reactive protein(CRP),neutrophil to lymphocyte ratio(NLR)and white blood cell count(WBC)in the auxiliary diagnosis and prognosis evaluation of sepsis.Methods In a retrospective study,seventy-two patients with sepsis diagnosed and treated in Tianjin First Central Hospital from June 2018 to April 2021 were selected as the research objects,and included in the sepsis group were 46 males and 26 females,aged 68(57.3,80.3)years.In addition,111 patients with local infection admitted to hospital during the same period were included in the local infection group,including 62 males and 49 females,aged 68(51,77)years.Sepsis patients were divided into survival group(43 cases)and death group(29 cases)according to the 28-day outcome.CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)ratio were detected by flow cytometry within 24 h after admission,PCT was detected by ELISA,CRP was detected by immunoturbidimetry,blood routine examination,blood lactic acid(Lac)and oxygen partial pressure(PO2)were detected by instrumental method.Multivariate Logistic regression analysis was used to evaluate the correlation between each indicator and sepsis,and receiver operating characteristic curve(ROC)was drawn to evaluate the diagnostic value of each indicator for sepsis.Multivariate Logistic regression analysis and Kaplan Meier survival analysis were used to evaluate the prognostic value of each index for patients with sepsis.Results Peripheral blood CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)ratio and PLT in sepsis group were significantly lower than those in local infection group(Z=-8.184,P<0.001;Z=-7.210,P<0.001;Z=-5.936,P<0.001;Z=-2.700,P=0.007;Z=-6.381,P<0.001);PCT,CRP,NLR and Lac levels were significantly higher than those in local infection group(Z=-8.262,P<0.001;Z=-3.094,P=0.002;Z=-9.004,P<0.001;Z=-4.770,P<0.001).Multivariate Logistic regression model showed that PCT,NLR,CD3^(+),CD8^(+),CD4^(+)/CD8^(+)were independent risk factors for sepsis.According to ROC curve analysis,AUC of sepsis patients diagnosed by each indicator were 0.862,0.894,0.858,0.760 and 0.618,respectively.The cut-off values were 3.075 ng/ml,10.715,44.935×109/L,27.463×109/L and 0.750,respectively.The NLR sensitivity was 80.6%,and the CD3^(+)specificity was 94.6%.The AUC of combined detection of PCT and NLR was 0.947,sensitivity was 87.5%and specificity was 91.9%.The combined detection AUC of PCT,NLR,CD3^(+),CD4^(+)/CD8^(+)was 0.958,the sensitivity and specificity were 90.3%and 91.0%respectively(P<0.001).PCT and Lac in death group were significantly higher than those in survival group(Z=-2.302,P=0.021;Z=-3.095,P=0.002);Peripheral blood CD4^(+)/CD8^(+)levels were significantly lower than those in survival group(Z=-3.691,P<0.001),Multivariate Logistic regression model showed that CD4^(+)/CD8^(+)ratio was an independent risk factor for 28 d mortality in patients with sepsis(P<0.001).The ROC curve showed that the AUC was 0.758,and the Youden index reached the maximum when the cut-off value was 1.27,the sensitivity and specificity were 79.3%and 60.5%,respectively.Compared with patients with CD4^(+)/CD8^(+)≥1.27,28-day mortality was significantly increased in patients with CD4^(+)/CD8^(+)<1.27(P=0.032).Conclusion The combined detection of PCT,NLR,CD3^(+)and CD4^(+)/CD8^(+)can improve the auxiliary diagnostic efficiency of sepsis,and the ratio of CD4^(+)/CD8^(+)in peripheral blood may have certain predictive value for the prognosis of sepsis.
作者
李丰帆
杨磊
王东强
何文菊
王策
穆红
Li Fengfan;Yang Lei;Wang Dongqiang;He Wenju;Wang Ce;Mu Hong(The First Central Clinical College of Tianjin Medical University,Clinical Laboratory,Tianjin First Central Hospital,Key Laboratory of Tianjin Institute of Emergency Medicine,Tianjin 300192,China;Department of Integrated Traditional and Western Medicine,Tianjin First Central Hospital,Tianjin 300192,China)
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2022年第4期494-502,共9页
Chinese Journal of Preventive Medicine
基金
国家自然科学基金(81973800)
天津市第一中心医院春苗项目(2019CM15)。
关键词
脓毒症
感染
淋巴细胞亚群
诊断
预后
Sepsis
Infections
Lymphocyte subsets
Diagnosis
Prognosis
