脓毒症合并代谢综合征患者免疫功能变化研究
|
摘要
目的探讨脓毒症合并代谢综合征(MS)患者在脓毒症不同分期时免疫状态的变化特点及其对预后的影响。方法前瞻性选取2014年1月—2017年6月在海南医学院第二附属医院急诊科住院治疗的脓毒症患者200例为研究对象,根据是否合并MS和脓毒症状态分成MS全身炎症反应综合征组(MSS组,50例)、MS严重脓毒症组(MSSS组,50例)、非MS的全身炎症反应综合征组(NMSS组,50例)、非MS严重脓毒症组(NMSSS组,50例),另选取50例本院健康体检者作为对照组。再根据预后将脓毒症患者分为存活亚组和死亡亚组。分别检测各组外周血T淋巴细胞相关免疫指标[包括CD_3阳性T淋巴细胞(CD_3~+T淋巴细胞)、CD_4阳性T淋巴细胞(CD_4~+T淋巴细胞)、CD_8阳性T淋巴细胞(CD_8~+T淋巴细胞)及CD_4~+T淋巴细胞/CD_8~+T淋巴细胞]并进行比较。结果 MSSS组急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)、感染相关器官功能衰竭评分系统(SOFA)评分高于MSS组,NMSSS组高于NMSS组(P<0.05);MSSS组SOFA评分高于NMSSS组(P<0.05)。4组脓毒症患者CD_3~+T淋巴细胞、CD_4~+T淋巴细胞、CD_8~+T淋巴细胞均低于对照组(P<0.05)。MSSS组和NMSSS组患者CD_3~+T、CD_4~+T及CD_8~+T低于MSS组(P<0.05),MSSS组低于NMSSS组(P<0.05)。MSSS组与NMSSS组28 d病死率高于MSS组与NMSS组(P<0.05),MSSS组28 d病死率高于NMSSS组(P<0.05)。死亡亚组APACHEⅡ评分、SOFA评分及MS发生率高于存活亚组,CD_3~+T、CD_4~+T、CD_8~+T及CD_4~+T/CD_8~+T低于存活亚组(P<0.05)。结论 MS可加重脓毒症患者细胞免疫抑制及病情,从而影响其预后。
Objective To investigate the characteristics of immune status in patients with sepsis complicated by different stages of metabolic syndrome(MS),and their effects on prognosis.Methods A total of 200 patients with sepsis who were hospitalized in the Department of Emergency,the Second Affiliated Hospital of Hainan Medical University between January 2014 and June 2017 were prospectively selected and divided into the following four groups according to the presence of MS complication and MS status:MS systemic inflammatory syndrome group(MSS group,50 cases),MS severe sepsis group(MSSS group,50 cases),non-MS systemic inflammatory syndrome group(NMSS group,50 cases)and non-MS severe sepsis group(NMSSS group,50 cases).A control group included 50 persons who received a health examination in our hospital.Patients with sepsis were also divided into a survival subgroup and a death subgroup.The peripheral blood T-lymphocyte-related immunological indicators(CD_3~+T,CD_4~+T,CD_8~+T,CD_4~+T/CD_8~+T)in each group were tested and compared.Results The Acute Physiology and Chronic Health Evaluation systemⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)scores in the MSSS group were higher than those in the MSS group(P<0.05),and the APACHEⅡand SOFA scores in the NMSSS group were higher than those in the NMSS group(P<0.05).The SOFA score in the MSSS group was higher than that in the NMSSS group(P<0.05).The percentages of T lymphocytes in the sepsis groups were all lower than that in the control group(P<0.05).The levels of CD_3~+T,CD_4~+T and CD_8~+T cells were lower in the MSSS group and NMSSS group than the MSS group(P<0.05),and lower in the MSSS group than the NMSSS group(P<0.05).The MSSS and NMSSS groups had higher mortality than did the MSS and NMSS groups(P<0.05),and the mortality in the MSSS group was higher than that in the NMSSS group(P<0.05).The APACHEⅡand SOFA scores,and the incidence of MS in the death subgroup were all higher than those in the survival subgroup,and the levels of CD_3~+T,CD_4~+T,CD_8~+T and CD_4~+T/CD_8~+T were lower in the death subgroup than the survival subgroup(P<0.05).Conclusion MS aggravates immunosuppression and disease severity in patients with sepsis and affects their prognosis.
Objective To investigate the characteristics of immune status in patients with sepsis complicated by different stages of metabolic syndrome(MS),and their effects on prognosis.Methods A total of 200 patients with sepsis who were hospitalized in the Department of Emergency,the Second Affiliated Hospital of Hainan Medical University between January 2014 and June 2017 were prospectively selected and divided into the following four groups according to the presence of MS complication and MS status:MS systemic inflammatory syndrome group(MSS group,50 cases),MS severe sepsis group(MSSS group,50 cases),non-MS systemic inflammatory syndrome group(NMSS group,50 cases)and non-MS severe sepsis group(NMSSS group,50 cases).A control group included 50 persons who received a health examination in our hospital.Patients with sepsis were also divided into a survival subgroup and a death subgroup.The peripheral blood T-lymphocyte-related immunological indicators(CD_3~+T,CD_4~+T,CD_8~+T,CD_4~+T/CD_8~+T)in each group were tested and compared.Results The Acute Physiology and Chronic Health Evaluation systemⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)scores in the MSSS group were higher than those in the MSS group(P<0.05),and the APACHEⅡand SOFA scores in the NMSSS group were higher than those in the NMSS group(P<0.05).The SOFA score in the MSSS group was higher than that in the NMSSS group(P<0.05).The percentages of T lymphocytes in the sepsis groups were all lower than that in the control group(P<0.05).The levels of CD_3~+T,CD_4~+T and CD_8~+T cells were lower in the MSSS group and NMSSS group than the MSS group(P<0.05),and lower in the MSSS group than the NMSSS group(P<0.05).The MSSS and NMSSS groups had higher mortality than did the MSS and NMSS groups(P<0.05),and the mortality in the MSSS group was higher than that in the NMSSS group(P<0.05).The APACHEⅡand SOFA scores,and the incidence of MS in the death subgroup were all higher than those in the survival subgroup,and the levels of CD_3~+T,CD_4~+T,CD_8~+T and CD_4~+T/CD_8~+T were lower in the death subgroup than the survival subgroup(P<0.05).Conclusion MS aggravates immunosuppression and disease severity in patients with sepsis and affects their prognosis.
引文
[1]BOOMER J S,TO K,CHANG K C,et al.Immunosuppression in patients who die of sepsis and multiple organ failure[J].JAMA,2011,306(23):2594-2605.DOI:10.1001/jama.2011.1829.
[2]胡宾,周玉杰.代谢综合征发病机制的研究进展[J].中华老年心脑血管病杂志,2012,14(3):328-329.DOI:10.3969/j.issn.1009-0126.2012.03.033.HU B,ZHOU Y J.Research progress on the pathogenesis of metabolic syndrome[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2012,14(3):328-329.DOI:10.3969/j.issn.1009-0126.2012.03.033.
[3]DELLINGER R P,LEVY M M,RHODES A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.DOI:10.1007/s00134-012-2769-8.
[4]马中书,冯晓路,朱萍.代谢综合征与相关疾病的临床研究进展[J].中国全科医学,2015,18(17):1991-1995.DOI:10.3969/j.issn.1007-9572.2015.17.002.MA Z S,FENG X L,ZHU P.Research progress on metabolic syndrome and its related diseases[J].Chinese General Practice,2015,18(17):1991-1995.DOI:10.3969/j.issn.1007-9572.2015.17.002.
[5]魏捷,孙胜男,吕菁君.降钙素原对免疫功能异常的脓毒症患者病情评估和预后判断[J].中华急诊医学杂志,2013,22(8):902-906.DOI:10.3760/cma.j.issn.1671-0282.2013.08.024.WEI J,SUN S N,LYU J J.Diagnostic and predict value of procalcitonin in ICU patients diagnosis of sepsis with immune system defect[J].Chinese Journal of Emergency Medicine,2013,22(8):902-906.DOI:10.3760/cma.j.issn.1671-0282.2013.08.024.
[6]张风雷,冯领周,袁燕,等.代谢综合征对冠状动脉血流速度的影响[J].中国全科医学,2015,18(17):2009-2013.DOI:10.3969/j.issn.1007-9572.2015.17.006.ZHANG F L,FENG L Z,YUAN Y,et al.Influences of metabolic syndrome on coronary blood flow velocity[J].Chinese General Practice,2015,18(17):2009-2013.DOI:10.3969/j.isn.1007-9572.2015.17.006.
[7]潘东峰,李富荣,梁诗颂,等.淋巴细胞亚群预测脓毒症患者死亡风险的主成分分析[J].中国全科医学,2015,18(8):919-923.DOI:10.3969/J.i SSn.1007-9572.2015.08.015.PAN D F,LI F R,LIANG S S,et al.Lymphocyte subsets to predict the principal component of risk of death in sepsis patients[J].Chinese General Practice,2015,18(8):919-923.DOI:10.3969/J.i SSn.1007-9572.2015.08.015.
[8]ROBINSON K,KRUGER P,PRINS J,et al.The metabolic syndrome in critically ill patients[J].Best Pract Clin Endocrinol Metab,2011,25(5):835-845.DOI:10.1016/j.beem.2011.04.008.
[9]SAHIN C,ERYILDIRIM B,CETINEL A C,et al.Does metabolic syndrome increase the risk of infective complications after prostate biopsy?A critical evaluation[J].International Urology and Nephrology,2015,47(3):423-429.DOI:10.1007/s11255-014-0904-x.
[10]INOUE S,SUZUKI-UTSUNOMIYA K,OKADA Y,et al.Reduction of immunocompetent T cells followed by prolonged lymphopenia in severe sepsis in the elderly[J].CritCare Med,2013,41(3):810-819.DOI:10.1097/CCM.0b013e318274645f.
[11]高爽,张放,马帅,等.脓毒症急性肾损伤与免疫功能的相关性研究[J].中华急诊医学杂志,2015,24(4):416-421.DOI:10.3760/cma.j.issn.1671-0282.2015.04.018.GAO S,ZHANG F,MA S,et al.A correlation study between septic acute kidney injury and immune function[J].Chinese Journal of Emergency Medicine,2015,24(4):416-421.DOI:10.3760/cma.j.issn.1671-0282.2015.04.018.
[12]苏杭,柴艳芬.糖尿病对脓毒症患者病原菌分布及预后的影响[J].中华临床医师杂志:电子版,2016,10(9):79-82.DOI:10.3877/cma.j.issn.1674-0785.2016.09.018.SU H,CHAI Y F.Effect of diabetes on the spectrum of pathogenic bacteria and prognosis of patients with sepsis[J].Chinese Journal of Clinicians(Electronic Edition),2016,10(9):79-82.DOI:10.3877/cma.j.issn.1674-0785.2016.09.018.2017122020180420
[2]胡宾,周玉杰.代谢综合征发病机制的研究进展[J].中华老年心脑血管病杂志,2012,14(3):328-329.DOI:10.3969/j.issn.1009-0126.2012.03.033.HU B,ZHOU Y J.Research progress on the pathogenesis of metabolic syndrome[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2012,14(3):328-329.DOI:10.3969/j.issn.1009-0126.2012.03.033.
[3]DELLINGER R P,LEVY M M,RHODES A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.DOI:10.1007/s00134-012-2769-8.
[4]马中书,冯晓路,朱萍.代谢综合征与相关疾病的临床研究进展[J].中国全科医学,2015,18(17):1991-1995.DOI:10.3969/j.issn.1007-9572.2015.17.002.MA Z S,FENG X L,ZHU P.Research progress on metabolic syndrome and its related diseases[J].Chinese General Practice,2015,18(17):1991-1995.DOI:10.3969/j.issn.1007-9572.2015.17.002.
[5]魏捷,孙胜男,吕菁君.降钙素原对免疫功能异常的脓毒症患者病情评估和预后判断[J].中华急诊医学杂志,2013,22(8):902-906.DOI:10.3760/cma.j.issn.1671-0282.2013.08.024.WEI J,SUN S N,LYU J J.Diagnostic and predict value of procalcitonin in ICU patients diagnosis of sepsis with immune system defect[J].Chinese Journal of Emergency Medicine,2013,22(8):902-906.DOI:10.3760/cma.j.issn.1671-0282.2013.08.024.
[6]张风雷,冯领周,袁燕,等.代谢综合征对冠状动脉血流速度的影响[J].中国全科医学,2015,18(17):2009-2013.DOI:10.3969/j.issn.1007-9572.2015.17.006.ZHANG F L,FENG L Z,YUAN Y,et al.Influences of metabolic syndrome on coronary blood flow velocity[J].Chinese General Practice,2015,18(17):2009-2013.DOI:10.3969/j.isn.1007-9572.2015.17.006.
[7]潘东峰,李富荣,梁诗颂,等.淋巴细胞亚群预测脓毒症患者死亡风险的主成分分析[J].中国全科医学,2015,18(8):919-923.DOI:10.3969/J.i SSn.1007-9572.2015.08.015.PAN D F,LI F R,LIANG S S,et al.Lymphocyte subsets to predict the principal component of risk of death in sepsis patients[J].Chinese General Practice,2015,18(8):919-923.DOI:10.3969/J.i SSn.1007-9572.2015.08.015.
[8]ROBINSON K,KRUGER P,PRINS J,et al.The metabolic syndrome in critically ill patients[J].Best Pract Clin Endocrinol Metab,2011,25(5):835-845.DOI:10.1016/j.beem.2011.04.008.
[9]SAHIN C,ERYILDIRIM B,CETINEL A C,et al.Does metabolic syndrome increase the risk of infective complications after prostate biopsy?A critical evaluation[J].International Urology and Nephrology,2015,47(3):423-429.DOI:10.1007/s11255-014-0904-x.
[10]INOUE S,SUZUKI-UTSUNOMIYA K,OKADA Y,et al.Reduction of immunocompetent T cells followed by prolonged lymphopenia in severe sepsis in the elderly[J].CritCare Med,2013,41(3):810-819.DOI:10.1097/CCM.0b013e318274645f.
[11]高爽,张放,马帅,等.脓毒症急性肾损伤与免疫功能的相关性研究[J].中华急诊医学杂志,2015,24(4):416-421.DOI:10.3760/cma.j.issn.1671-0282.2015.04.018.GAO S,ZHANG F,MA S,et al.A correlation study between septic acute kidney injury and immune function[J].Chinese Journal of Emergency Medicine,2015,24(4):416-421.DOI:10.3760/cma.j.issn.1671-0282.2015.04.018.
[12]苏杭,柴艳芬.糖尿病对脓毒症患者病原菌分布及预后的影响[J].中华临床医师杂志:电子版,2016,10(9):79-82.DOI:10.3877/cma.j.issn.1674-0785.2016.09.018.SU H,CHAI Y F.Effect of diabetes on the spectrum of pathogenic bacteria and prognosis of patients with sepsis[J].Chinese Journal of Clinicians(Electronic Edition),2016,10(9):79-82.DOI:10.3877/cma.j.issn.1674-0785.2016.09.018.2017122020180420