[1]唐小莉,方长太,陈园园.CD4+T细胞百分比、淋巴细胞对老年脓毒症继发慢重症的临床应用价值[J].医学信息,2023,36(12):102-106.[doi:10.3969/j.issn.1006-1959.2023.12.019]
　TANG Xiao-li,FANG Chang-tai,CHEN Yuan-yuan.The Clinical Application Value of the Percentage of CD4+T Cell and Lymphocyte in Elderly Patients with Chronic Critical Illness After Sepsis[J].Journal of Medical Information,2023,36(12):102-106.[doi:10.3969/j.issn.1006-1959.2023.12.019]
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CD4+T细胞百分比、淋巴细胞对老年脓毒症继发慢重症的临床应用价值()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年12期
页码:
102-106
栏目:
论著
出版日期:
2023-06-15

文章信息/Info

Title:
The Clinical Application Value of the Percentage of CD4+T Cell and Lymphocyte in Elderly Patients with Chronic Critical Illness After Sepsis
文章编号:
1006-1959（2023）12-0102-05
作者:
唐小莉; 方长太; 陈园园
（安徽医科大学安庆医学中心重症医学科，安徽 安庆 246000）
Author(s):
TANG Xiao-li; FANG Chang-tai; CHEN Yuan-yuan
(Intensive Care Unit,Anqing Medical Center to Anhui Medical University,Anqing 246000,Anhui,China）
关键词:
脓毒症; 淋巴细胞; CD4+T细胞; 慢性重症; 免疫抑制
Keywords:
Sepsis; Lymphocyte; CD4+T cell; Chronic criticall illness; Immunosuppression
分类号:
R459.7
DOI:
10.3969/j.issn.1006-1959.2023.12.019
文献标志码:
A
摘要:
目的 探讨CD4+T细胞百分比联合外周血淋巴细胞计数对老年脓毒症继发慢重症患者的早期识别价值。方法 收集安徽医科大学安庆医学中心重症医学科2020年12月-2022年4月收治的75例年龄≥65岁脓毒症患者临床资料，根据CCI定义分为CCI组35例（死亡20例），非CCI组40例（死亡11例）。入选者均抽取第1、3、7天晨起空腹血标本，检测CD4+T细胞百分比及外周血淋巴细胞计数。采用二元Logistic回归分析老年脓毒症继发慢重症的危险因素。绘制受试者工作特征曲线（ROC曲线），分析动态CD4+T细胞百分比及外周血淋巴细胞对老年脓毒症继发慢重症的诊断价值，并与急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）相比较。结果 两组性别、年龄、白细胞计数、中性粒细胞计数、血小板计数、血清肌酐、尿素氮、白蛋白、乳酸，第1天淋巴细胞计数、连续性肾脏替代治疗（CRRT）及住院时间比较，差异无统计学意义（P＞0.05）；两组C-反应蛋白、降钙素原、APACHEⅡ评分、序贯器官衰竭评分（SOFA），第1、3、7天的CD4+T百分比，第3、7天的淋巴细胞计数比较，差异有统计学意义（P＜0.05）；二元Logistic回归分析显示，第3天CD4+T细胞百分比及APACHEⅡ评分是老年脓毒症继发慢重症的独立危险因素[第3天CD4+T细胞百分比：OR=1.244，95%CI：1.020~1.517，P=0.000；APACHEⅡ评分：OR=0.458，95%CI：0.265~0.794，P=0.000]；绘制第3天CD4+T细胞百分比ROC曲线得出AUC面积0.803，灵敏度为94.30%、特异度为57.50%，最佳截断值为35.55[95%CI：0.705~0.900，P＜0.05]；APACHEⅡ评分ROC曲线得出AUC面积为0.885，灵敏度为91.40%、特异度为72.50%，最佳截断值为13.5[95%CI：0.812~0.958，P＜0.05]。结论 第3天CD4+T细胞百分比、APACHEⅡ评分是老年脓毒症继发慢重症的独立危险因素。APACHEⅡ评分诊断老年脓毒症继发慢重症价值高于CD4+T百分比细胞。
Abstract:
Objective To investigate the value of the percentage of CD4+T cell combined with peripheral blood lymphocyte count in the early identification of chronic critical liiness patients with sepsis.Methods The clinical data of 75 sepsis patients aged ≥65 years admitted to the Intensive Care Unit, Anqing Medical Center to Anhui Medical University from December 2020 to April 2022 were collected. According to the definition of CCI, they were divided into CCI group (35 patients, 20 deaths) and non-CCI group (40 patients, 11 deaths). Fasting blood samples were taken from the morning of the first, third and seventh days to detect the percentage of CD4+ T and peripheral blood lymphocyte count. Binary Logistic regression was used to analyze the risk factors of elderly patients with chronic critical illness after sepsis. The receiver operating characteristic curve (ROC curve) was drawn to analyze the diagnostic value of dynamic the percentage of CD4+T and peripheral blood lymphocytes for elderly patients with chronic critical illness after sepsis, and compared with acute physiology and chronic health evaluation Ⅱ (APACHEⅡ).Results There were no significant differences in gender, age, white blood cell count, neutrophil count, platelet count, serum creatinine, urea nitrogen, albumin, lactic acid, lymphocyte count on the first day, continuous renal replacement therapy (CRRT) and hospitalization time between the two groups (P>0.05). There were significant differences in C-reactive protein, procalcitonin, APACHEⅡ score, sequential organ failure score (SOFA), the percentage of CD4+T on the 1st, 3rd and 7th day, lymphocyte count on the 3rd and 7th day between the two groups (P<0.05). Binary logistic regression analysis showed that the percentage of CD4+T on 3rd day and APACHEⅡ score were independent risk factors for elderly patients with chronic critical illness after sepsis [the percentage of CD4+T on 3rd day: OR=1.244, 95%CI: 1.020-1.517, P=0.000; APACHEⅡ score: OR=0.458, 95%CI: 0.265-0.794, P=0.000]; the ROC curve of percentage of CD4+T on 3rd day was drawn, and the AUC area was 0.803, the sensitivity was 94.30%, the specificity was 57.50%, and the best cutoff value was 35.55 [95%CI: 0.705-0.900, P<0.05]. The ROC curve of APACHEⅡ score showed that the AUC area was 0.885, the sensitivity was 91.40%, the specificity was 72.50%, and the optimal cutoff value was 13.5[95%CI: 0.812-0.958, P<0.05].Conclusion The percentage of CD4+T on the 3d day and APACHEⅡ score are independent risk factors for elderly patients with chronic critical illness after sepsis. The value of APACHEⅡ score in the diagnosis of elderly patients with chronic critical illness after sepsis is higher than that of the percentage of CD4+T cell.

参考文献/References:

[1]Evans L,Rhodes A,Alhazzani W,et al.Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J].Intensive Care Med,2021,47(11):1181-1247.[2]谢剑锋,邱海波.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的进展与评论[J].中华重症医学电子杂志,2017,3(1):18-25.[3]陈亮,曹日进,王金莉,等.脓毒症继发慢性重症患者临床特征分析[J].中华危重病急救医学,2021,33(12):1414-1417.[4]Ono S,Tsujimoto H,Hiraki S,et al.Mechanisms of sepsis-induced immunosuppression and immunological modification therapies for sepsis[J].Ann Gastroenterol Surg,2018,2(5):351-358.[5]Stortz JA,Mira JC,Raymond SL,et al.Benchmarking clinical outcomes and the immunocatabolic phenotype of chronic critical illness after sepsis in surgical intensive care unit patients[J].Trauma Acute Care Surg,2018,84(2):342-349.[6]Gardner AK,Ghita GL,Wang Z,et al.The Development of Chronic Critical Illness DeterminesPhysical Function,Quality of Life,and Long-Term Survival Among Early Survivors of Sepsisin Surgical ICUs[J].Crit Care Med,2019,47(4):566-573.[7]leischmann C,Scherag A,Adhikari NK,et al.Assessment of Global Incidence and Mortality of Hospital-treated Sepsis.Current Estimates and Limitations[J].Am J Respir Crit Care Med,2016,193(3):259-272.[8]Yende S,Kellum JA,Talisa VB,et al.Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis[J].JAMA Netw Open,2019,2(8):e198686.[9]Hibbert JE,Currie A,Strunk T.Sepsis-Induced Immunosuppression in Neonates[J].Front Pediatr,2018,6:357.[10]王虎,张姣姣,孙俊楠,等.白介素-6联合CD4+T淋巴细胞百分比对脓毒症患者预后的评估价值[J].内科理论与实践,2021,16(6):404-408.[11]Oami T,Watanabe E,Hatano M,et al.Suppression of T Cell Autophagy Results in Decreased Viability and Function of T Cells Through Accelerated Apoptosis in a Murine Sepsis Model[J].Crit Care Med,2017,45(1):e77-e85.[12]王宗培,谢智慧,赵玉洁,等.共刺激分子程序性细胞死亡受体-1/程序性细胞死亡受体配体-1调控树突状细胞对脓毒症患者免疫功能的影响[J].中华危重病急救医学,2021,33(9):1032-1039.[13]钟坚,李少洪,陈金成,等.动态监测降钙素原联合T细胞亚群PD-1表达水平对脓毒症预后的预测价值[J].分子诊断与治疗杂志,2021,13(6):933-937.[14]叶瑞,胡炜,刘炳炜.脓毒症患者T淋巴细胞亚群变化及与炎症状态的关系研究[J].中国现代医学杂志,2019,29(17):41-47.[15]程储记,方长太,汪文婧,等.脓毒症患者血清IL-35与CD4+ T细胞的表达及相互调控作用研究[J].中华医院感染学杂志,2019,29(15):2265-2269,2279.[16]Stortz JA,Murphy TJ,Raymond SL,et al.Evidence for Persistent Immune Suppression in Patients Who Develop Chronic Critical Illness After Sepsis[J].Shock,2018,49(3):249-258.[17]Hohlstein P,Gussen H,Bartneck M,et al.Prognostic Relevance of Altered Lymphocyte Subpopulations in Critical Illness and Sepsis[J].J Clin Med,2019,8(3):353.[18]黄琴,廖晓斌,吴贵全.急性生理与慢性健康Ⅱ评分联合血清降钙素原、D-二聚体、乳酸清除率预测重症脓毒症患者预后不良[J].中华实验和临床感染病杂志(电子版),2021,15(6):394-401.[19]梁青,杨晰晰,温彬.APACHEⅡ评分、PAR与老年脓毒症病情严重程度的关系及对短期预后的预测价值[J].临床误诊误治,2021,34(4):64-70.

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更新日期/Last Update: 1900-01-01