72例急危重病人免疫功能变化的临床研究

发布时间：2018-05-05 22:17

本文选题：急危重症 + 淋巴细胞亚群　；参考：《皖南医学院》2015年硕士论文

【摘要】：目的:观察急危重症患者淋巴细胞亚群以及总蛋白(Total Protein,TP)、白蛋白(Albumin,ALB)、球蛋白(Globulin,GLOB)、C反应蛋白(C-reactive Protein,CRP)的变化,了解急危重病患者的免疫功能状态,为临床诊治各种急危重症提供理论依据。方法:收集2013年9月-2015年2月在弋矶山医院住院的急危重症患者116例,筛选符合标准的急危重症患者72例(危重症组),同时选取来自我院体检中心的健康人群44例(对照组)。入院24小时(Hour,h)内抽取患者静脉血,用流式细胞术定量分析淋巴细胞亚群,包括CD3+T细胞、CD4+T细胞、CD3+CD8+T细胞、CD3-CD16+56+细胞、CD3-CD19+细胞百分数和CD4+/CD8+比值;并于入院第2天(Day,d)空腹抽取静脉血行生化检测,检测患者各项指标,并与健康人群进行比较。应用SPSS 17.0进行统计分析。结果:急危重症病人外周血CD3+T、CD3+CD4+T、CD3-CD19+细胞百分数、CD4+/CD8+比值与健康人群比较降低[(56.63±6.19)%与(69.84±4.82)%、(29.23±4.25)%与(35.55±4.88)%、(12.40±3.35)%与(15.13±2.79)%、(1.30±0.33)与(1.50±0.34)],CD8+T细胞百分数升高[(26.91±5.70)%与(24.50±4.22)%],差异有统计学意义(P0.05),两组患者外周血CD3-CD16+56+百分数差异无统计学意义(P0.05)。急危重症病人血清CRP浓度高于健康人群[(80.52±17.76)mg/L与(0.47±0.08)mg/L],差异有显著统计学意义(P0.01),TP、ALB、GLOB浓度低于健康人群[(53.74±5.48)g/L与(75.02±4.14)g/L、(28.09±3.95)g/L与(46.87±3.13)g/L、(25.74±3.65)g/L与(27.97±2.91)g/L],差异有统计学意义(P0.05)。入选的72例急危重症病人,根据入院后28d死亡与否分为存活组36例,死亡组36例。死亡组患者外周血CD3+T、CD3+CD4+T以及CD3-CD19+细胞百分数均低于存活组患者[(53.41±4.84)%与(59.85±5.73)%、(27.93±3.76)%与(30.52±4.38)%、(11.14±3.31)%与(13.67±2.93)%],差异具有统计学意义(P0.05),两组患者外周血CD8+T、CD3-CD16+56+细胞百分数、CD4+/CD8+比值差异无统计学意义(P0.05),死亡组患者血清CRP浓度高于存活组[(93.69±9.98)mg/L与(66.22±9.58)mg/L],TP、ALB浓度低于存活组[(51.86±4.85)g/L与(55.63±5.47)g/L、(26.83±3.17)g/L与(29.91±3.07)g/L],差异具有统计学意义(P0.05),两组患者血清GLOB浓度差异无统计学意义(P0.05)。相关性分析结果:CD3+T淋巴细胞百分比与CRP水平呈负相关(r=-0.544,P=0.000)。ROC曲线显示CD3+、CD3+CD4+、CD3-CD19+淋巴细胞百分数以及血清CRP、TP、ALB浓度能够预测急危重症患者的预后,曲线下面积(AUC)分别为0.807、0.619、0.717、0.970、0.693、0.738。结论:1.急危重症患者外周血CD3+、CD4+、CD3-CD19+淋巴细胞百分数、CD4+/CD8+比值降低,CD8+T细胞百分数升高,提示患者存在细胞免疫功能紊乱。2.患者血清总蛋白及白蛋白浓度低,C反应蛋白浓度明显升高,提示患者体液免疫功能紊乱。3.CD3+T淋巴细胞百分比与CRP水平呈负相关。4.外周血CD3+T、CD3+CD4+T、CD3-CD19+细胞百分数以及血清CRP、TP、ALB浓度对于急危重症病人的预后有一定的意义。其中,ROC曲线分析得到CRP的最佳界值点为85.15mg/ml,CD3+淋巴细胞百分数的最佳界值点为56.4%。
[Abstract]:Objective: To observe the changes of lymphocyte subsets and Total Protein (TP), albumin (Albumin, ALB), Globulin (GLOB), Globulin (GLOB), C reactive protein (C-reactive Protein, CRP), to understand the immune function state of patients with acute and severe disease, and to provide a theoretical basis for clinical diagnosis and treatment of acute critically ill patients. Methods: 9 in 2013. 116 acute critically ill patients hospitalized at Yi San Shan Hospital in February, -2015, were selected to select 72 cases of critical critically ill patients (critical group), and 44 healthy people from the physical examination center of our hospital (control group) were selected. The venous blood was extracted from the hospital for 24 hours (Hour, H), and the lymphocyte subgroups were quantitatively analyzed by flow cytometry, including CD3. +T cells, CD4+T cells, CD3+CD8+T cells, CD3-CD16+56+ cells, the percentage of CD3-CD19+ cells and the ratio of CD4+/CD8+, and the biochemical detection of venous blood from the empty stomach on the second day (Day, d) on the hospital. The indexes of the patients were detected and compared with those of the healthy population. The statistical analysis was carried out with SPSS 17. The results were: CD3+T, CD3+CD4 in peripheral blood of acute critically ill patients. The percentage of +T, CD3-CD19+ cells, and the ratio of CD4+/CD8+ to healthy people were lower [(56.63 + 6.19)% and (69.84 + 4.82)%, (29.23 + 4.25)% and (35.55 + 4.88)%, (12.40 + 3.35)% and (15.13 + 2.79)%, (1.30 +%) and (4.25)%), and the difference was statistically significant (P0.05), and the difference was statistically significant (P0.05). There was no significant difference in the percentage of CD3-CD16+56+ in peripheral blood (P0.05). The serum CRP concentration in acute critical patients was higher than that of healthy people [(80.52 + 17.76) mg/L and (0.47 + 0.08) mg/L], the difference was statistically significant (P0.01), TP, ALB, GLOB concentration was lower than that of healthy people [(53.74 + 5.48) g/L and (75.02 + 4.14) g/L, (28.09 + 3.95) g/L and (46.87 + 3.13)) /L, (25.74 + 3.65) g/L and (27.97 + 2.91) g/L], the difference was statistically significant (P0.05). 72 patients with acute critical illness were divided into 36 cases of survival and 36 cases in the death group. The percentage of CD3+T, CD3+CD4+T and CD3-CD19+ cells in the peripheral blood of the death group were lower than those of the survival group [(53.41 + 4.84)% and (59.85 +)% (59.85 + 5.73)%, (2) (2). 7.93 + 3.76% and (30.52 + 4.38)%, (11.14 + 3.31)% and (13.67 + 2.93)%], the difference was statistically significant (P0.05). There was no significant difference in the percentage of CD8+T, CD3-CD16+56+ cells in the peripheral blood of the two groups and the ratio of CD4+/CD8+ (P0.05). The serum CRP concentration in the death group was higher than that of the survival group [(93.69 + 9.98) mg/L and (66.22 + 9.58) mg/L], TP, ALB concentration Lower than survival group [(51.86 + 4.85) g/L and (55.63 + 5.47) g/L, (26.83 + 3.17) g/L and (29.91 + 3.07) g/L], the difference was statistically significant (P0.05). The difference of serum GLOB concentration in the two groups was not statistically significant (P0.05). The correlation analysis showed that the percentage of CD3+T lymphocytes was negatively correlated with the level of CRP (r=-0.544, P=0.000).ROC curves showed The percentage of CD4+, CD3-CD19+ lymphocyte and serum CRP, TP, and ALB can predict the prognosis of patients with acute severe disease. The area under the curve (AUC) is 0.807,0.619,0.717,0.970,0.693,0.738. conclusion, respectively: 1. the percentage of CD3+, CD4+, CD3-CD19+ lymphocytes, CD4+/CD8+ ratio, and the increase of CD8+T cell percentage in peripheral blood of acute critically ill patients. The serum total protein and albumin concentration in patients with cellular immune dysfunction.2. was low, and the concentration of C reactive protein increased significantly. The percentage of.3.CD3+T lymphocyte in the patient's humoral immune dysfunction was negatively correlated with CD3+T in.4. peripheral blood, CD3+CD4+T, CD3-CD19+ cell percentage and serum CRP, TP, ALB concentration in acute risk. The prognosis of severe patients has certain significance. Among them, the best boundary value point of CRP is 85.15mg/ml, and the best boundary point of the percentage of CD3+ lymphocyte is 56.4%. with the ROC curve analysis.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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