脓毒症患儿免疫抑制与多器官功能障碍相关性研究

发布时间：2018-09-03 13:56

【摘要】：目的研究脓毒症患儿免疫水平与病情严重程度的相关性,探讨免疫抑制对器官功能损害的影响。方法回顾分析375例脓毒症患儿的临床资料,分析患儿转入重症监护室24小时内免疫功能指标与器官损害数之间的关系;Logistic逐步回归分析发生多器官功能障碍综合征(MODS)及院内死亡的风险因素。结果 375例脓毒症患儿中位年龄8.7个月(1个月~13岁),男228例、女147例,男女比例约1.55:1。依据治疗期间发生功能障碍的器官数目,将脓毒症患儿分为无器官功能障碍组、单器官功能障碍组及多器官功能障碍组。三组间NK细胞百分比,CD4/CD8比值,补体C3、C4水平的差异均有统计学意义(P0.05),以多器官功能障碍组最低。Logistic多因素回归分析显示,CD4/CD8比值(OR=0.66,95%CI:0.51~0.85)、补体C 3(OR=0.20,95%CI:0.10~0.42)、中枢神经系统感染(OR=2.54,95%CI:1.35~4.77)和肺部感染(OR=2.29,95%CI:1.36~3.83)是MODS发生的影响因素;补体C3(OR=0.26,95%CI:0.09~0.76)及肺部感染(OR=2.61,95%CI:1.12~6.09)为脓毒症患儿院内死亡的影响因素。结论脓毒症患儿的免疫抑制与MODS发生有相关性,CD 4/CD 8比值降低以及补体C 3消耗可作为评估脓毒症患儿MODS发生风险的免疫学指标。
[Abstract]:Objective To study the correlation between immune level and severity of sepsis, and to explore the effect of immunosuppression on organ damage. Methods The clinical data of 375 children with sepsis were retrospectively analyzed. Results The median age of 375 children with sepsis was 8.7 months (1 month to 13 years old), 228 males and 147 females. The ratio of male to female was about 1.55:1. According to the number of organs with dysfunction during treatment, the children with sepsis were divided into non-organ dysfunction group and single organ dysfunction group. The differences of NK cell percentage, CD4/CD8 ratio, complement C3 and C4 levels among the three groups were statistically significant (P 0.05). The lowest was in the multiple organ dysfunction group. Logistic multivariate regression analysis showed that CD4/CD8 ratio (OR = 0.66, 95% CI: 0.51-0.85), complement C3 (OR = 0.20, 95% CI: 0.10-0.42), central nervous system infection (CNS infection). OR = 2.54,95% CI: 1.35-4.77 and pulmonary infection (OR = 2.29,95% CI: 1.36-3.83) were the influencing factors of MODS, complement C3 (OR = 0.26,95% CI: 0.09-0.76) and pulmonary infection (OR = 2.61,95% CI: 1.12-6.09) were the influencing factors of hospital mortality in sepsis children. And complement C 3 consumption can be used as an immunological indicator to assess the risk of MODS in children with sepsis.
【作者单位】：南京医科大学附属儿童医院检验科;
【分类号】：R720.597

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