摘要
目的探讨脓毒症患者淋巴细胞亚群联合Th1/Th2细胞因子等相关指标的特征,为早期识别脓毒症生物标志物变化及判断预后提供思路。方法收集脓毒症患者84例,根据疾病转归分为预后良好组和预后不良组,同期选取120名健康人作为对照组。流式细胞仪检测外周血淋巴细胞亚群(CD3^(+)、CD4^(+)T、CD8^(+)T细胞、CD19^(+)B细胞、NK细胞)及血清Th1/Th2细胞因子谱白介素2(IL-2)、白介素4(IL-4)、白介素6(IL-6)、白介素10(IL-10)、γ-干扰素(IFN-γ)和α-肿瘤坏死因子(TNF-α)水平;全自动血液分析仪检测白细胞、中性粒细胞、血小板、中性粒细胞和淋巴细胞的比值(NLR)等;全自动血浆蛋白分析仪检测C反应蛋白(CRP);免疫层析法检测降钙素原(PCT);全自动血凝分析仪检测PT、APTT;血气分析(氧分压、乳酸、二氧化碳分压等)。Pearson方法分析细胞因子和淋巴细胞亚群的相关性,二元logistic回归分析评价各指标与脓毒症严重程度的关联,绘制受试者工作特征曲线(ROC)评价各指标对脓毒症的诊断价值。结果与对照组相比,脓毒症组CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD3^(-)CD16^(+)56^(+)、CD3^(-)CD19^(+)数量及CD4^(+)/CD8^(+)比值显著性下降,TNF-α、IL-6水平显著性升高(P<0.05)。脓毒症患者预后良好组和预后不良组相比,CD4/CD8比值及IL-6水平差异有统计学意义(P<0.05)。Pearson相关性分析显示,患者血清CD8^(+)T细胞和IL-2水平间呈正相关(P<0.05);二元logistic回归分析CD4/CD8比值为影响脓毒症的独立危险因素;ROC曲线结果显示,IL-6、TNF-α、CD4/CD8比值对于脓毒症病情的评估具有较好的临床价值。结论脓毒症患者TNF-α、IL-6、CD4/CD8比值对脓毒症监测及预后判断具有较好的临床参考价值。
Objective To explore the characteristic analysis of lymphocyte subsets combined with Th1/Th2 cytokines in patients with sepsis,so as to provide idea for early identification of changes in biomarkers of sepsis and evaluation of prognosis.Methods 84 patients with emergency department and ICU sepsis were collected.The patients were divided into a good prognosis group and a bad prognosis group according to the transfer of the disease.At the same time,120 healthy people were selected as the control group.Flow cytometry detecting peripheral blood lymphocyte subsets(CD3^(+),CD4^(+)T,CD8^(+)cells,CD19^(+)B cells,NK cells)and serum Th1/Th2 cytokine spectrum(IL-2,IL-4,IL-6,IL-10,IFN-γ,TNF-α);NLR was the ratio of neutrophils to lymphocytes;the white blood cells,neutrophils and platelets were detected by fully automatic blood analyzer;C-reactive protein(CRP)and immunochromatography detects Pro Calcitonin(PCT)were detected by fully automatic plasma protein analyzer;PT and APTT were detected by fully automatic blood coagulation analyzer;Blood gas analysis was used for examining oxygen partial pressure,lactic acid and carbon dioxide partial pressure,etc.The correlation between each indicator and the severity of sepsis,and draws the subject′s working feature curve(ROC)were analyzed for evaluating the diagnostic value of each indicator for sepsis.Results Compared with the control group,the number of CD3^(+),CD3^(+)CD4^(+),CD3^(+)CD8^(+),CD3-CD16^(+)56^(+),CD3-CD19^(+)and the ratio of CD4^(+)/CD8^(+)in the septic group were decreased significantly,and the levels of TNF-α and IL-6 were increased significantly(P<0.05).Compared with the prognosis group and the poor prognosis group,the difference between CD4/CD8 ratio and IL-6 levels was statistically significant(P<0.05).Pearson correlation analysis showed that there was a positive correlation between the patient′s serum CD8^(+)T cells and IL-2 levels(P<0.05);the binary Logistic regression analysis CD4/CD8 ratio was an independent risk factor affecting sepsis;ROC curve results show It shows that the ratios of IL-6,TNF-αand CD4/CD8 ratio had good clinical value for the evaluation of sepsis.Conclusion The TNF-α,IL-6 and CD4/CD8 ratio of patients with sepsis have good clinical reference value for sepsis monitoring and prognosis judgment.
作者
杜沛静
侯晓慧
尹晓丽
王良方
张玉英
王琳琳
崔洁
潘琳
王利茹
师志云
DU Peijing;HOU Xiaohui;YIN Xiaoli;WANG Liangfang;ZHANG Yuying;WANG Linlin;CUI Jie;PAN Lin;WANG Liru;SHI Zhiyun(Medical Experimental Center of General Hospital of Ningxia Medical University,Yinchuan 750004,China;School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China)
出处
《宁夏医学杂志》
CAS
2023年第5期401-404,I0001,共5页
Ningxia Medical Journal
基金
宁夏自然科学基金项目(2021AAC03326)。
