T淋巴细胞、炎性因子及心肌酶对脓毒症严重程度的评估价值研究
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摘要
目的探讨脓毒症患者T淋巴细胞、炎性因子及心肌酶对疾病严重程度的评估价值。方法收集2015年9月—2017年9月北京市怀柔区妇幼保健院收治的脓毒症患者82例,根据病情程度分为一般性脓毒症组37例、严重性脓毒症组28例及脓毒性休克组17例,另选同期来我院行健康体检的健康者60例作为对照组。检测82例脓毒症患者及体检健康者入组时T淋巴细胞、炎性因子及心肌酶指标变化情况。结果一般性脓毒症组、严重性脓毒症组及脓毒性休克组入组时CD3+、CD4+、CD8+及CD4+/CD8+水平均低于对照组(P<0.05);严重性脓毒症及脓毒性休克组CD3+、CD4+及CD8+水平均低于一般性脓毒症组(P<0.05)。一般性脓毒症、严重性脓毒症及脓毒性休克组入组时血清降钙素原(PCT)、C-反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)水平均显著高于对照组(P<0.05);严重性脓毒症及脓毒性休克组PCT、CRP及TNF-α水平均明显高于一般性脓毒症组(P<0.05);脓毒性休克组PCT及TNF-α水平均明显高于严重性脓毒症组(P<0.05)。一般性脓毒症、严重性脓毒症及脓毒性休克组入组时天冬氨酸转氨酶、乳酸脱氢酶、心肌型肌酸激酶同工酶、肌酸激酶水平均显著高于对照组(P<0.05);严重性脓毒症及脓毒性休克组各心肌酶指标水平均明显高于一般性脓毒症组(P<0.05);脓毒性休克组各心肌酶指标水平均明显高于严重性脓毒症组(P<0.05)。结论 T淋巴细胞水平越低、炎性因子及心肌酶水平越高,脓毒症患者的病情越严重,T淋巴细胞、炎性因子及心肌酶有望成为临床评估脓毒症病情严重程度的标志物。
Objective To explore the value of T lymphocytes,inflammatory factors and myocardial enzymes in the assessment of the severity of sepsis.Methods Eighty-two patients with sepsis who were admitted to Beijing Huairou District Maternal and Child Health Hospital from September 2015 to September 2017 were divided into general sepsis group(n=37),severe sepsis group(n=28) and septic shock group(n=17) according to the severity of the disease.Sixty healthy people who underwent physical examination in our hospital during the same period served as the control gorup.The changes of T lymphocytes,inflammatory factors and myocardial enzymes were detected in82 patients with sepsis and in healthy subjects on admission.Results The levels of CD3+,CD4+,CD8+and CD4+/CD8+in general sepsis group,severe sepsis group and septic shock group were lower than those in control group on admission(P<0.05).The levels of CD3+,CD4+and CD8+in severe sepsis and septic shock group were lower than those in general sepsis group(P<0.05).The serum levels of procalcitonin(PCT),C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α) in general sepsis,severe sepsis and septic shock groups at baseline were significantly higher than those in the control group(P<0.05).The levels of PCT,CRP and TNF-α in severe sepsis group and septic shock group were remarkably higher than those in general sepsis group(P<0.05).The levels of PCT and TNF-α in septic shock group were significantly higher than those in severe sepsis group(P<0.05).The levels of aspartate aminotransferase(AST),lactate dehydrogenase(LDH),myocardial creatine kinase isoenzyme(CK-MB) and creatine kinase(CK) in the general sepsis,severe sepsis and septic shock groups at baseline were significantly higher than those in the control group(P<0.05).The levels of myocardial enzyme AST,LDH,CK and CK-MB in severe sepsis group and septic shock group were notably higher than those in general sepsis group(P<0.05).The levels of myocardial enzyme AST,LDH,CK and CK-MB in septic shock group were significantly higher than those in severe sepsis group(P<0.05).Conclusion The lower the level of T lymphocytes,the higher the level of inflammatory factors and myocardial enzymes,the more severe the condition of sepsis patients.T lymphocytes,inflammatory factors and myocardial enzymes are expected to become clinical markers to assess the severity of sepsis.
Objective To explore the value of T lymphocytes,inflammatory factors and myocardial enzymes in the assessment of the severity of sepsis.Methods Eighty-two patients with sepsis who were admitted to Beijing Huairou District Maternal and Child Health Hospital from September 2015 to September 2017 were divided into general sepsis group(n=37),severe sepsis group(n=28) and septic shock group(n=17) according to the severity of the disease.Sixty healthy people who underwent physical examination in our hospital during the same period served as the control gorup.The changes of T lymphocytes,inflammatory factors and myocardial enzymes were detected in82 patients with sepsis and in healthy subjects on admission.Results The levels of CD3+,CD4+,CD8+and CD4+/CD8+in general sepsis group,severe sepsis group and septic shock group were lower than those in control group on admission(P<0.05).The levels of CD3+,CD4+and CD8+in severe sepsis and septic shock group were lower than those in general sepsis group(P<0.05).The serum levels of procalcitonin(PCT),C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α) in general sepsis,severe sepsis and septic shock groups at baseline were significantly higher than those in the control group(P<0.05).The levels of PCT,CRP and TNF-α in severe sepsis group and septic shock group were remarkably higher than those in general sepsis group(P<0.05).The levels of PCT and TNF-α in septic shock group were significantly higher than those in severe sepsis group(P<0.05).The levels of aspartate aminotransferase(AST),lactate dehydrogenase(LDH),myocardial creatine kinase isoenzyme(CK-MB) and creatine kinase(CK) in the general sepsis,severe sepsis and septic shock groups at baseline were significantly higher than those in the control group(P<0.05).The levels of myocardial enzyme AST,LDH,CK and CK-MB in severe sepsis group and septic shock group were notably higher than those in general sepsis group(P<0.05).The levels of myocardial enzyme AST,LDH,CK and CK-MB in septic shock group were significantly higher than those in severe sepsis group(P<0.05).Conclusion The lower the level of T lymphocytes,the higher the level of inflammatory factors and myocardial enzymes,the more severe the condition of sepsis patients.T lymphocytes,inflammatory factors and myocardial enzymes are expected to become clinical markers to assess the severity of sepsis.
引文
[1]陈伟,胡志华,陈勉.脓毒症患者血浆中抗AT-Ⅲ水平测定的临床意义[J].海南医学院学报,2015,21(8):1060-1063.
[2]Scheer C,Fuchs C,Rehberg S.Biomarkers in Severe Sepsis and Septic Shock:Just Listen to the Heart[J].Critical Care Medicine,2016,44(4):849-850.
[3]陈淳桑,袁聪聪,刘秋红,等.脓毒症发展过程中肺部T淋巴细胞亚群变化及其意义[J].内科急危重症杂志,2016,22(2):153-155.
[4]陈建,张勇.血必净注射液对脓毒症患者的炎性反应和凝血功能的影响[J].湖南师范大学学报(医学版),2016,13(2):105-107.
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[6]江利冰,李瑞杰,张斌,等.2016年脓毒症与脓毒性休克处理国际指南[J].中华急诊医学杂志,2017,26(3):263-266.
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[8]李婷婷,赵欣欣,王萃.小儿脓毒症血清C反应蛋白和心肌酶变化及临床意义[J].实用心脑肺血管病杂志,2006,14(2):106-107.
[9]玉章锋,秦海东,鲍磊,等.脓毒症休克合并急性肾损伤早期诊断研究[J].实用老年医学,2012,26(3):203-206.
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[11]高峰,常建水,李晶,等.以横纹肌溶解症为首发表现的脓毒症诊疗反思[J].临床误诊误治,2014,27(10):46-49.
[12]杨桂香,杜晓刚,陈雪梅.脓毒症免疫调理治疗的研究进展[J].医学综述,2016,22(17):3333-3336.
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[14]陈涛,臧彬.脓毒症及脓毒性休克患者T淋巴细胞亚群变化研究[J].临床军医杂志,2017,45(1):46-48.
[15]李秀华,陈永铭,洪亮,等.低剂量氢化可的松对感染性休克患者外周血胸腺依赖性淋巴细胞凋亡的影响[J].中华急诊医学杂志,2010,19(5):528-532.
[16]王硕,李丽娜,齐文升,等.炎症反应调控与脓毒症防治方法进展[J].现代仪器与医疗,2018,24(5):26-28.
[17]Ji Z,Li Q,Fu W,et al.Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy[J].Urolithiasis,2015,43(1):41-47.
[18]董宏艳,刘先华,周智勇,等.降钙素原和APACHⅡ评分对老年脓毒症患者病情判断及预后评估的研究[J].实用老年医学,2015(6):457-460.
[19]夏为,侯云生,卞晓华.血浆PCT及NGAL水平对多发伤并脓毒症的预测价值[J].临床误诊误治,2016,29(6):81-84.
[20]Mcdonald M L N,Cho M H,Sorheim I C,et al.Common genetic variants associated with resting oxygenation in chronic obstructive pulmonary disease[J].Am J Respir Cell Mol Biol,2014,51(5):678-687.
[21]詹文丽,苏显都.血清降钙素原和C反应蛋白在脓毒性休克患者中的变化及对预后的评估[J].中国感染控制杂志,2017,16(2):160-165.
[22]钟伟州,刘青山,欧远通,等.脓毒症患者休克指数与炎症反应、氧化应激反应、靶器官损伤的相关性研究[J].海南医学院学报,2017,23(4):464-466.
[23]Li Z,Wang H,Liu J,et al.Serum soluble triggering receptor expressed on myeloid cells-1 and procalcitonin can reflect sepsis severity and predict prognosis:a prospective cohort study[J].Mediators Inflamm,2014,2014:641039.
[24]王胜云,陈德昌.降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J].中华危重病急救医学,2015,27(2):97-101.
[25]党晓燕,秦勇,丁新爱,等.NT-pro BNP、血小板及胆固醇水平与脓毒症预后的相关性[J].临床误诊误治,2013,26(7):80-83.
[2]Scheer C,Fuchs C,Rehberg S.Biomarkers in Severe Sepsis and Septic Shock:Just Listen to the Heart[J].Critical Care Medicine,2016,44(4):849-850.
[3]陈淳桑,袁聪聪,刘秋红,等.脓毒症发展过程中肺部T淋巴细胞亚群变化及其意义[J].内科急危重症杂志,2016,22(2):153-155.
[4]陈建,张勇.血必净注射液对脓毒症患者的炎性反应和凝血功能的影响[J].湖南师范大学学报(医学版),2016,13(2):105-107.
[5]张萌,段美丽,李昂.脓毒症心肌功能障碍中西医诊治进展[J].北京中医药,2016,35(10):992-995.
[6]江利冰,李瑞杰,张斌,等.2016年脓毒症与脓毒性休克处理国际指南[J].中华急诊医学杂志,2017,26(3):263-266.
[7]Werdan K,Pilz G,Bujdoso,et al.Score-based immunoglobulin G therapy of patients with sepsis:the SBITS study[J].Crit Care Med,2007,35(12):2693-2701.
[8]李婷婷,赵欣欣,王萃.小儿脓毒症血清C反应蛋白和心肌酶变化及临床意义[J].实用心脑肺血管病杂志,2006,14(2):106-107.
[9]玉章锋,秦海东,鲍磊,等.脓毒症休克合并急性肾损伤早期诊断研究[J].实用老年医学,2012,26(3):203-206.
[10]Vincent J L,Marshall J C,Namendys-Silva S A,et al.Assessment of the worldwide burden of critical illness:the intensive care over nations(ICON)audit[J].Lancet Respir Med,2014,2(5):380-386.
[11]高峰,常建水,李晶,等.以横纹肌溶解症为首发表现的脓毒症诊疗反思[J].临床误诊误治,2014,27(10):46-49.
[12]杨桂香,杜晓刚,陈雪梅.脓毒症免疫调理治疗的研究进展[J].医学综述,2016,22(17):3333-3336.
[13]Nogueira C V,Zhang X,Giovannone N,et al.Protective immunity against Chlamydia trachomatis can engage both CD4+and CD8+T cells and bridge the respiratory and genital mucosae[J].J Immunol,2015,194(5):2319-2329.
[14]陈涛,臧彬.脓毒症及脓毒性休克患者T淋巴细胞亚群变化研究[J].临床军医杂志,2017,45(1):46-48.
[15]李秀华,陈永铭,洪亮,等.低剂量氢化可的松对感染性休克患者外周血胸腺依赖性淋巴细胞凋亡的影响[J].中华急诊医学杂志,2010,19(5):528-532.
[16]王硕,李丽娜,齐文升,等.炎症反应调控与脓毒症防治方法进展[J].现代仪器与医疗,2018,24(5):26-28.
[17]Ji Z,Li Q,Fu W,et al.Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy[J].Urolithiasis,2015,43(1):41-47.
[18]董宏艳,刘先华,周智勇,等.降钙素原和APACHⅡ评分对老年脓毒症患者病情判断及预后评估的研究[J].实用老年医学,2015(6):457-460.
[19]夏为,侯云生,卞晓华.血浆PCT及NGAL水平对多发伤并脓毒症的预测价值[J].临床误诊误治,2016,29(6):81-84.
[20]Mcdonald M L N,Cho M H,Sorheim I C,et al.Common genetic variants associated with resting oxygenation in chronic obstructive pulmonary disease[J].Am J Respir Cell Mol Biol,2014,51(5):678-687.
[21]詹文丽,苏显都.血清降钙素原和C反应蛋白在脓毒性休克患者中的变化及对预后的评估[J].中国感染控制杂志,2017,16(2):160-165.
[22]钟伟州,刘青山,欧远通,等.脓毒症患者休克指数与炎症反应、氧化应激反应、靶器官损伤的相关性研究[J].海南医学院学报,2017,23(4):464-466.
[23]Li Z,Wang H,Liu J,et al.Serum soluble triggering receptor expressed on myeloid cells-1 and procalcitonin can reflect sepsis severity and predict prognosis:a prospective cohort study[J].Mediators Inflamm,2014,2014:641039.
[24]王胜云,陈德昌.降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J].中华危重病急救医学,2015,27(2):97-101.
[25]党晓燕,秦勇,丁新爱,等.NT-pro BNP、血小板及胆固醇水平与脓毒症预后的相关性[J].临床误诊误治,2013,26(7):80-83.