摘要
目的分析脓毒症患者外周血中调节性T细胞(regulatory T cell,Treg)、辅助性T细胞17(T helper cell 17,Th17)、Th17/Treg的变化及其与预后的关系。方法选取徐州医科大学附属连云港医院2020年12月~2021年10月收治EICU和ICU的63例脓毒症患者作为研究对象。采取患者入院24h内的外周血行流式细胞术检测Treg和Th17,同时记录一般资料并进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官衰竭评分(SOFA评分)。采用ROC曲线评估各指标对预后的预测价值,Logistic回归分析影响患者28天病死率的相关因素。结果最终纳入50例脓毒症患者,其中存活组33例,死亡组17例。与存活组比较,死亡组中性粒细胞淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、系统免疫炎症指数(SII)、降钙素原(PCT)、Th17、Th17/Treg明显高于存活组,淋巴细胞计数明显低于存活组,差异均有统计学意义(P<0.05)。以患者28天结局为因变量行ROC曲线分析,NLR、SOFA评分、Th17/Treg曲线下面积(AUC)分别为0.749、0.776、0.834,NLR阈值为27.295,敏感度为64.7%,特异性为90.9%;SOFA评分阈值为12.5,敏感度为58.8%,特异性为87.9%;Th17/Treg阈值为0.116,敏感度为82.4%,特异性为85.8%。结论Th17/Treg与患者病情严重程度及预后有关。
Objective To analyze the changes of regulatory T cells(Treg),T helper cell 17(Th17)and Th17/Treg in peripheral blood of patients with sepsis and their relationship with prognosis.Methods 63 septic patients with EICU and ICU admitted to Lianyungang Hospital of Xuzhou Medical University from December 2020 to October 2021 were selected as the study,who were divided into sepsis group and septic shock group.They were divided into survival group and death group by the 28-day outcome.The peripheral blood of the patients within 24 hours after admission was taken to detect Treg and Th17 by flow cytometry.At the same time,the general data were recorded and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and sequential organ failure assessment score(SOFA score)were recorded.The prognostic value of each index was evaluated by ROC curve,and the related factors affecting 28-day death were analyzed by Logistic regression.Results 50 patients with sepsis were included,including 33 patients in survival group and 17 patients in death group.Compared with the survivors,the levels of NLR,PLR,SII,PCT,Th17 and Th17/Treg in the dead group were significantly higher than those in the survival group,while the lymphocyte count was significantly lower than that in the survival group(P<0.05).Taking the 28-day outcome of the patient as the dependent variable,the area under the ROC curve(AUC)of NLR,SOFA score and Th17/Treg were 0.749,0.776 and 0.834 respectively.The NLR threshold was 27.295,the sensitivity was 64.7%,and the specificity was 90.9%;the SOFA score threshold was 12.5,and the sensitivity was 58.8%,the specificity was 87.9%;the Th17/Treg threshold was 0.116,the sensitivity was 82.4%,and the specificity was 85.8%.Conclusion Th17/Treg is related to the severity and prognosis of patients,and can be used as another marker for the treatment of sepsis.
作者
黄守秋
陈晓兵
李帆
孙艳
王言理
孙文
李小民
HUANG Shouqiu;CHEN Xiaobing;LI Fan(The Affiliated Lianyungang Hospital of Xuzhou Medical University,Jiangsu 222002,China)
出处
《医学研究杂志》
2022年第6期108-112,102,共6页
Journal of Medical Research
基金
江苏省连云港市卫生健康委员会科技项目(QN1804)。
