免疫功能改变对脓毒症患者预后的影响

目的:评价检测脓毒症患者免疫指标变化对其预后的预测作用。方法:选取2012年1月至2012年12月在本院ICU住院治疗的90例脓毒症患者,于入院时及治疗第4天抽取静脉血分析T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8及HLA-DR比例情况。同时对患者自入院起,进行APACHEⅡ评分及SOFA评分。根据患者最终转归分为存活组及死亡组。比较两组患者T淋巴细胞亚群变化情况及与APACHEⅡ评分及SOFA评分的相关性。结果:脓毒症存活组APACHEⅡ评分及SOFA评分较死亡组低,且随着治疗有明显下降趋势。而死亡组APACHEⅡ评分及SOFA评分一直处于较高水平,并没有随着治疗开展而下降。入院时,脓毒症存活组及死亡组CD4/CD8及HLA-DR均低于正常范围,经治疗后,存活组CD3、CD4、CD4/CD8及HLA-DR比例均出现上升,达到正常范围,而死亡组D4,CD3,CD4,CD4/CD8及HLA-DR比例均出现明显下降,低于正常水平,且明显低于存活组。T淋巴细胞亚群比例与APACHEⅡ评分及SOFA评分呈负相关。结论:T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8及HLA-DR比例变化情况对脓毒症患者预后有较好预测价值,持续降低提示患者预后不良。

The prospective value of the immunity function change in patients with sepsis

Objective To analyze the immunity fuction change(peripheral blood lymphocyte subsets) and prognosis prospective value in patients with sepsis.Methods A total of 90 patients with sepsis from Jan.2012 to Dec.2012 were included into the study.T lymphocyte subgroups(CD 3,CD4,CD4/CD8,HLA-DR)was analyzed in all patients in first and fourth day.The APACHE on the patient Ⅱ grading and SOFA grading was analyzed.The patients were divided into survival group and the death group.The T lymphocyte subgroup and APACHE on the patient Ⅱ grading and SOFA grading were analysis in the two groups.Results The APACHE grading and SOFA grading in the death group was higher than the survival group.The APACHE grading and SOFA grading in the death group had no changes after the treatment.But the grading in the survival group was reduced.The ratios CD3,CD4,CD4+/CD8+ and HLA-DR in death group showed difference from the survival group after treatment.It was significant lower than survival.Conclusion The T lymphocyte subsets monitor has good prospective value to the patients with sepsis.