血清降钙素原联合T淋巴细胞亚群及中性粒细胞CD64对脓毒症病情程度与预后的评估价值

doi:10.3969/j.issn.1004-583X.2018.07.004

临床荟萃

血清降钙素原联合T淋巴细胞亚群及中性粒细胞CD64对脓毒症病情程度与预后的评估价值

1.邢台市人民医院 a.急诊科；b.呼吸内科，河北邢台 054000；2.河北医科大学第三医院急诊科, 河北石家庄 050051

出版日期:2018-07-05 发布日期:2018-08-06
通讯作者: 通信作者：董士民，Email:dsm_123@163.com
作者简介:宋中海, 邢台市人民医院急诊急救部主治医师，急诊医学硕士， 2008年参加工作，邢台市医师协会委员，邢台市医师协会急诊分会委员，擅长各类急危重症疾病的救治，发表国内期刊论文数篇，被邢台市共青团授予邢台市青年文明号称号，代表河北省医学会急诊分会参加全国急诊医学年会学术交流发言，获得河北省中医药协会科学进步一等奖一项。

Clinical value of serum procalcitonin, T lymphocyte subsets and neutrophil CD64 in evaluating the severity and prognosis of patients with sepsis

1a.Department of Emergency； 1b.Department of Respiratory Medicine, Xingtai People's Hospital,
Xingtai 054000，China; 2.Department of Emergency, the Third Hospital of Hebei Medical University,
Shijiazhuang 050051, China

Online:2018-07-05 Published:2018-08-06
Contact: Corresponding author: Dong Shimin, dsm_123@163.com

摘要/Abstract

摘要： 目的探讨脓毒症患者血清降钙素原（PCT）、T淋巴细胞亚群、中性粒细胞CD64百分比、危重症评分等指标对病情评估及预后判断价值。方法检测入院后24小时内、第7天血清PCT、T淋巴细胞亚群、中性粒细胞CD64百分比等指标，计算急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）和序贯器官衰竭评分（SOFA）。分析上述指标与病情严重程度的关联性以及对预后判断价值。结果 ①共纳入72例脓毒症患者，总病死率为31.9%。28天病死率脓毒症组为19.57%；脓毒症休克组为53.85%，差异有统计学意义（P＜0.05）；②脓毒症休克组入院24小时内血清PCT、CD64（%）、APACHE Ⅱ及SOFA评分均高于脓毒症组，T淋巴细胞亚群CD4+/CD8+比值低于脓毒症组（P＜0.05）；③死亡组入院7天时血清PCT、CD64（%）、APACHE Ⅱ及SOFA评分均高于存活组， T淋巴细胞亚群CD4+/CD8+比值低于存活组（P＜0.05）。不同时间点血清PCT与APACHE Ⅱ评分均呈正相关（r分别为0.702， 0.637，P＜0.01）；不同时间点的T淋巴细胞亚群CD4+/CD8+比值与APACHE Ⅱ评分均呈负相关（r分别为-0.691，-0.659， P＜0.01）；不同时间点的中性粒细胞CD64百分比与APACHEⅡ评分均呈正相关（r分别为0.676，0.622，P＜0.01）；不同时间点的SOFA评分与APACHE Ⅱ评分均呈正相关（r分别为0.663，0.762，P＜0.01）；④血清PCT、T淋巴细胞亚群、中性粒细胞CD64百分比、APACHE Ⅱ评分及SOFA评分均为影响脓毒症预后的独立因素（P＜0.05）。以上5项指标对患者28天预后评价能力相当。通过Z检验比较3项检测指标联合和单一指标检测的AUC，差异有统计学意义（P＜0.05）。结论血清PCT、中性粒细胞CD64百分比、T淋巴细胞亚群CD4+/CD8+比值、SOFA评分及APACHE Ⅱ评分可作为判断脓毒症病情严重程度的指标。多项指标联合对预后判断具有更高的敏感性和特异性。

关键词: 脓毒症, 降钙素原, 中性粒细胞CD64, T淋巴细胞亚群分组, SOFA评分, APACHE Ⅱ评分, 预后

Abstract: Objective To explore the diagnostic and prognostic value of serum procalcitonin (PCT), the level of neutrophil CD64, the percentage of T lymphocyte subsets, SOFA score and APACHE Ⅱ score in patients with sepsis.Methods A total of 72 patients with sepsis were divided into the sepsis group and the septic shock group. The level of serum PCT, neutrophil percentage of CD64 and T lymphocyte subsets were measured, and APACHE Ⅱ score and SOFA score (five indicators) were calculated at the first day and the seventh day after admission.Logistic regression analysis and the receiver operating characteristic curve were applied to the probing of the relationship between those indicators and outcomes.Results ①Total mortality rate was 31.9%.The mortality rates of the two group were significantly different, with that of the sepsis group being 19.57% and septic shock group 53.85% (P=0.019). ②Compared with the sepsis group, the four indicators (namely, PCT，CD65（%）, APACHE Ⅱ and SOFA) of the septic shock group were all higher within the first 24 hour, but its ratio of T lymphocyte CD4+/CD8+ were lower than that of the sepsis group (P<0.05). ③Compared with the survival group, the abovementioned four indicators of the nonsurvival group within the first 24 hour were higher, but its ratio of T lymphocyte CD4+/CD8+ was relatively lower (P<0.05). ④Serum PCT and APACHE score were positively correlated at different time（r=0.702， 0.637，P＜0.01） , so were the percentge of CD64 and APACHE Ⅱ (r=0.676， 0.622，P<0.01), as well as SOFA and APACHE Ⅱ（r=0.676， 0.622，P＜0.01）, while the ratio of T lymphocyte CD4+/CD8+ and APACHE score were negatively related(P<0.01).⑤The five indicators above were all independent factors（P＜0.05） affecting the prognosis of sepsis patients and the more indicators combined, the higher sensitivity and specificity.Conclusion The serum PCT, the ratio of T lymphocyte CD4+/CD8+, neutrophil CD64(%), APACHE Ⅱ score and SOFA score can be used to assess the condition and risk of patients with sepsis. Combined together, these factors can have higher sensitivity and specificity in terms of the prognosis of patients with sepsis.

Key words: sepsis, procalcitonin, neutrophil CD64, T lymphocyte subsets, APACHE Ⅱ score, SOFA score, prognosis

宋中海1a，高辉1a，卢纯1b，董士民2. 血清降钙素原联合T淋巴细胞亚群及中性粒细胞CD64对脓毒症病情程度与预后的评估价值[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2018.07.004.

Song Zhonghai1a, Gao Hui1a, Lu Chun1b, Dong Shimin2. Clinical value of serum procalcitonin, T lymphocyte subsets and neutrophil CD64 in evaluating the severity and prognosis of patients with sepsis[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2018.07.004.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2018.07.004

https://huicui.hebmu.edu.cn/CN/Y2018/V33/I7/568

[1]	赵旭辉, 黄小敏, 达德转, 许焱, 崔晓东, 李红玲. 基于生物信息学筛选影响胃癌患者预后的糖酵解相关基因[J]. 临床荟萃, 2024, 39(1): 20-29.
[2]	黄赛虎, 龙中洁, 董兴强, 孟祥营, 吴水燕, 柏振江. 血液肿瘤患儿合并脓毒血症的病原学特点及临床特征[J]. 临床荟萃, 2024, 39(1): 38-42.
[3]	刘丽丽, 袁宇婷, 赖耿良, 田川, 蓝翔, 叶中绿. 儿童急性淋巴细胞白血病第15天微小残留与预后的关系[J]. 临床荟萃, 2024, 39(1): 47-52.
[4]	崔兰丹, 杨春燕. 脓毒症患者甲状腺激素的变化特点及研究进展[J]. 临床荟萃, 2024, 39(1): 70-74.
[5]	王涛, 高玉伟, 王兴华, 胡秀红, 崔红蕊, 徐保振, 杨洪娟. 抗磷脂酶A2受体抗体与特发性膜性肾病的相关性[J]. 临床荟萃, 2023, 38(7): 606-612.
[6]	高秦宇, 包蓓艳, 金燕, 赵宇. IgA肾病合并抑郁状态患者的临床特征和预后影响因素分析[J]. 临床荟萃, 2023, 38(6): 510-515.
[7]	孙星星, 林海. 儿童重症肺炎的免疫功能变化及预后危险因素[J]. 临床荟萃, 2023, 38(6): 521-525.
[8]	贺翔渝, 潘燕, 张小林. 血清脂蛋白相关磷脂酶A2水平与急性缺血性脑卒中病情及预后的关系[J]. 临床荟萃, 2023, 38(4): 315-318.
[9]	杨金强, 张仁敏. 降钙素原与血小板比值评估发热伴血小板减少综合征预后的价值[J]. 临床荟萃, 2023, 38(4): 346-351.
[10]	唐爱军, 汪丽韡. 脓毒症患者入院时血小板计数及凝血指标对28天生存状况的预测价值[J]. 临床荟萃, 2023, 38(3): 250-254.
[11]	张娜, 孙越, 董晗, 赵鹏, 杨昕, 祁源, 王玲玲. SPARC表达水平与非小细胞肺癌患者预后关系的meta分析[J]. 临床荟萃, 2023, 38(11): 972-978.
[12]	周利娟, 诸彭伟, 曹梅, 程真梅, 吴峤微, 李勇. 铁蛋白、红细胞参数及血浆D-二聚体与儿童脓毒症的相关性[J]. 临床荟萃, 2023, 38(1): 60-63.
[13]	王会新, 赵芳晴, 张馨妍, 侯晓雯. 中国人尿酸水平与急性缺血性脑卒中患者预后关系的meta分析[J]. 临床荟萃, 2022, 37(9): 785-790.
[14]	邢婷婷, 高俊茶. Presepsin在急性胰腺炎中的研究进展[J]. 临床荟萃, 2022, 37(8): 764-768.
[15]	轩晓倩, 赵君慧, 杨小茜. 炎性指标在非小细胞肺癌患者预后中的临床意义[J]. 临床荟萃, 2022, 37(7): 663-667.

血清降钙素原联合T淋巴细胞亚群及中性粒细胞CD64对脓毒症病情程度与预后的评估价值

Clinical value of serum procalcitonin, T lymphocyte subsets and neutrophil CD64 in evaluating the severity and prognosis of patients with sepsis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价