脓毒症患者早期淋巴细胞亚群和中性粒细胞与淋巴细胞比值的变化及其对预后的预测

Changes of lymphocyte subsets and ratio of neutrophils to lymphocytes at early phase of sepsis and its prognostic values

摘要:

目的 探讨脓毒症患者早期淋巴细胞亚群[T淋巴细胞亚群(CD4⁺T细胞、CD8⁺T细胞)、自然杀伤细胞(NK细胞)]计数和中性粒细胞与淋巴细胞比值(NLR)的变化及其对预后的预测价值。方法 选取山西医科大学第一医院重症医学科2019年12月至2020年12月收治的62例脓毒症患者,根据随访28d生存情况分为存活组和死亡组,监测并记录2组患者第1天和第3天的淋巴细胞亚群计数、NLR、急性生理和慢性健康状况评分Ⅱ(APACHE Ⅱ)以及序贯器官衰竭评估(SOFA),比较各指标与预后的关系,并评估预测价值。采用SPSS 26.0统计软件进行数据分析。根据数据类型,组间比较采用t检验、秩和检验或χ²检验。结果 第1天和第3天死亡组患者APACHEⅡ和SOFA均高于存活组(均P＜0.05)；第3天死亡组患者淋巴细胞计数、T淋巴细胞计数、CD4⁺T细胞计数、CD8⁺T细胞计数及NK细胞计数明显低于存活组患者(均P＜0.05),且与SOFA评分呈负相关(r=-0.19、-0.16、-0.17、-0.18、-0.26,P＜0.05)；NLR明显高于存活组患者(P＜0.05),且与APACHEⅡ评分呈正相关(r=0.45, P＜0.05)；APACHEⅡ评分、SOFA、NLR、淋巴细胞计数、T淋巴细胞计数、CD4⁺T细胞计数、CD8⁺T细胞计数、NK细胞计数对脓毒症患者28 d预后的受试者工作特征曲线下面积分别为0.84、0.73、0.76、0.84、0.83、0.81、0.82、0.78。结论 脓毒症患者早期会发生免疫抑制,T淋巴细胞亚群计数、NK细胞计数及NLR的变化对脓毒症患者预后均具有良好的临床预测价值。

Abstract:

Objective To investigate the charges of lymphocyte subset counts [CD4⁺ T cells, CD8⁺ T cells and natural killer (NK) cells] and the ratio of neutrophils to lymphocytes (NLR) in patients at the early phase of sepsis and its predictive values for the prognosis. Methods A total of 62 sepsis patients admitted to the First Hospital of Shanxi Medical University from December 2019 to December 2020 were included in this study. These patients were divided into survival group and death group according to their conditions of 28-day follow-up. T lymphocyte subsets, NK cell count, NLR, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score at day 1 and 3 after admission were measured and recorded, and the relationship of these indexes with patient prognosis and their predictive values were analyzed. SPSS statistics 26.0 was used to perform the statistical analysis. Student′s t test, Rank sum test or Chi-square test was employed for intergroup comparison depending on different data types. Results Compared with the survival group, the death group had significantly higher APACHEⅡ and SOFA scores on both day 1 and day 3 (P<0.05), obviously lower counts of lymphocytes, T lymphocytes, CD4⁺ T cells, CD8⁺ T cells and NK cells on day 3 (all P<0.05), whose counts were negatively correlated with SOFA score (r=-0.19, -0.16, -0.17, -0.18, -0.26; P<0.05), and notably higher NLR (P<0.05), which was positively correlated with APACHEⅡ score (r=0.45, P<0.05). The area under receiver operating characteristic curve (AUC) for APACHEⅡ score, SOFA score, NLR, lymphocyte count, T lymphocyte count, CD4+ T cell count, CD8+ T cell count, and NK cell count on day 3 for predicting patient′s 28-day prognosis were 0.84,0.73,0.76,0.84,0.83,0.81,0.82 and 0.78, respectively. Conclusion Immunosuppression occurs in the early phase of sepsis. T lymphocyte subset counts, NK cell count and NLR show good predictive values for prognosis in septic patients.