摘要
目的:探究T淋巴细胞亚群预测脓毒症患者的病情及预后的价值。方法:选取我院2021年1月-2022年6月收治的脓毒症住院患者作为脓毒症组(n=80),另选同时期于我院完成体检的健康者作为对照组(n=40),比较两组T淋巴细胞亚群水平、系统性炎症反应综合征,(systemic inflammatory response syndrome,SIRS)诊断结果,以及各T淋巴细胞亚群水平与SIRS各诊断指标之间的相关性。根据患者入院28d的预后情况,将患者分为存活组和死亡组,比较两组患者入院第1d、7d时的T淋巴细胞亚群水平,并通过二元分析Logistic回归分析及ROC曲线分析T淋巴细胞亚群对脓毒症患者预后的预测价值。结果:脓毒症患者入院时CD4^(+)、CD8^(+)水平及体温、心率、呼吸频率及白细胞计数均低于对照组,CD4^(+)/CD8^(+)水平高于对照组,组间差异具有统计学意义(P<0.05);脓毒症患者入院时CD4^(+)、CD4^(+)/CD8^(+)水平均与体温、心率、呼吸频率及白细胞计数均成反比,而CD8^(+)水平则与体温、心率、呼吸频率及白细胞计数均成正比(P<0.05);入院28d后,80例脓毒症患者中有22例死亡,死亡率为27.5%;死亡组患者入院第7d时T淋巴细胞亚群的CD4^(+)、CD4^(+)/CD8^(+)水平低于存活组,且低于入院第1d,CD8^(+)水平高于存活组,且高于入院第1d,组间、组内差异均具有统计学意义(P<0.05);存活组患者入院第7d时CD4^(+)、CD4^(+)/CD8^(+)水平均高于入院第1d,CD8^(+)水平低于入院第1d,组内差异具有统计学意义(P<0.05);二元Logistic回归分析结果显示,CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)均是影响脓毒症患者预后的独立影响因素(P<0.05);ROC曲线结果显示,CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)联合预测脓毒症患者预后的曲线下面积为0.955,灵敏度为0.864,特异性为0.983。结论:T淋巴细胞亚群水平的变化与脓毒症患者的病情密切相关,CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)联合可准确预测脓毒症患者的预后。
Objective:To explore the value of T lymphocyte subsets in predicting the condition and prognosis of patients with sepsis.Methods:The inpatients with sepsis admitted to our hospital from January 2021 to June 2022 were selected as the sepsis group(n=80),and healthy subjects who completed physical examination in our hospital during the same period were selected as the control group(n=40).Compared the levels of T lymphocyte subsets,the diagnostic results of systemic inflammatory response syndrome(SIRS),and the correlation between the levels of T lymphocyte subsets and various diagnostic indicators of SIRS between the two groups.According to the prognosis of the patients on the 28th day of admssion,the patients were divided into a survival group and a death group.The levels of T lymphocyte subsets on the 1st and 7th days of admision were compared between the two groups.Logistic regression analysis and ROC curve analysis were used to analyze the T lymphocyte subsets between the two groups.Predictive value of lymphocyte subsets for prognosis in patients with sepsis.Results:The levels of CD4^(+),CD8^(+),body temperature,heart rate,respiratory rate and white blood cell count of the patients with sepsis at admission were lower than those of the control group,and the levels of CD4^(+)/CD8^(+)were higher than those of the control group,and the difference between the groups was statistically significant(P<0.05).CD4^(+),CD4^(+)/CD8^(+)levels were inversely proportional to body temperature,heart rate,respiratory rate and white blood cell count at admission,while CD8^(+)level was proportional to body temperature,heart rate,respiratory rate and white blood cell count(P<0.05).After 28 days,22 of the 80 sepsis patients died,and the mortality rate was 27.5%;The CD4^(+) and CD4^(+)/CD8^(+)levels of T lymphocyte subsets in the death group were lower than those in the survival group on the 7th day of admision,and were lower than those in the survival group.On the 1st day,the level of CD8^(+)in the survival group was higher than that in the survival group,and it was higher than that on the 1st day of admission,and the differences between the groups and within the group were statistically significant(P<0.05).On the 1st day,the level of CD8^(+)was lower than that on the 1st day ofadmision,and the difference within the group was statistically significant(P<0.05).Binary Logistic regression analysis showed that CD4^(+),CD8^(+)and CD4^(+)^(+)/CD8^(+)were independent influences on the prognosis of patients with sepsis factor(P<0.05).ROC curve results showed that the area under the curve of CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)combined to predict the prognosis of patients with sepsis was 0.955,the sensitivity was 0.864,and the specificity was 0.983.Conclusion:The changes of T lymphocyte subsets levels are closely related to the condition of patients with sepsis.CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)combination can accurately predict the prognosis of patients with sepsis.
作者
牛静静
薛燕
杨洁
NIU Jingjing;XUE Yan;YANG Jie(Department of laboratory medicine,Sanmenxia Central Hospital,Henan Sanmenxia 472000)
出处
《医学检验与临床》
2023年第7期30-34,共5页
Medical Laboratory Science and Clinics
关键词
脓毒症
预后
T淋巴细胞亚群
病情
预测
Sepsis
Prognosis
T lymphocyte subsets
Disease condition
Prediction
