动态监测免疫相关指标评估危重症患者免疫功能和病情变化的价值

doi:10.3969/j.issn.1671-7171.2020.06.025

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摘要【目的】研究动态监测患者免疫相关指标评估危重症免疫功能和预测病情严重程度及结局。【方法】本院EICU收治的53例患者,根据患者28 d后死亡情况分为存活组36例,死亡组17例。测定患者d₁、d₃、d₇炎症指标白细胞介素6(IL-6)、IL-8、IL-10以及肿瘤坏死因子-α(TNF-α)水平及免疫相关指标降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、免疫球蛋白(IgA、IgM、IgG)、CD4⁺、CD8⁺、CD4⁺/CD8⁺。分析免疫相关指标评估危重症免疫功能和预测病情严重程度及结局的价值。【结果】入院d₃存活组IL-10显著低于死亡组(P<0.05);入院d₇存活组PCT显著低于死亡组,IL-6、IL-8显著高于死亡组(P<0.05)。入院d₁存活组患者IgA、IgM、CD8⁺水平显著低于死亡组(P<0.05);d₇存活组CD4⁺、CD4 ⁺/CD8⁺水平显著高于死亡组(P<0.05);PCT(d₇)、IL-10(d₃)、CD8⁺、急性生理学及慢性健康状况评分系统(APACHE Ⅱ评分)、全身感染相关性器官功能衰竭评价系统(SOFA评分)预测危重患者28 d病死率的敏感性和特异性较高(P<0.05)。【结论】危重症患者免疫功能都有损害,预后随着损害程度的增大而病死率越高。PCT、IL-10、CD8⁺能够预测患者不良愈后和死亡风险。动态监测免疫相关指标有利于评估免疫危重症患者严重程度和结局。

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	陶丹
	李鹏

关键词 ：危重病/免疫学, 免疫功能

Abstract：【Objective】To investigate the value of dynamic monitoring of immune-related indexes to evaluate immune function and predict disease severity and outcome in the critically ill patients. 【Methods】A total of 53 patients admitted to EICU of our hospital were selected in this study. According to the 28-day mortality, patients were divided into two groups: the survival group (n=36) and the death group (n=17). The peripheral venous blood on the 1st, 3rd, and 7th day after admission were collected for the inflammation indicators detection including interleukin-6 (IL-6),IL-8 and IL-10 and TNF-α, as well as the immunologically relevant indicators detection including PCT, hs-CRP, immunoglobulin (IgA, IgM, IgG), CD4⁺, CD8⁺, CD4⁺/CD8⁺. The patients' immune-related indicators were analyzed to assess critical immune function and predict the severity and outcome of the disease. 【Results】The IL-10 level in the survival group on the 3rd day of EICU was significantly lower than that in the death group (P<0.05). On the 7th day, the survival group had lower PCT level and higher levels of IL-6 and IL-8 than those of the death group (P<0.05). The levels of IgA, IgM and CD8⁺ in the survival group on the 1st day were significantly lower than those in the death group (P<0.05). The levels of CD4⁺ and CD4⁺/CD8⁺ on the 7th day in the survival group were significantly higher than those in the death group (P<0.05). The sensitivity and specificity of PCT (7th day), IL-10 (3rd day), CD8⁺, APACHE Ⅱ (acute physiology and chronic health status scoring system) score and SOFA (systemic infection-related organ failure evaluation system) score in the diagnosis of 28-day mortality in critically ill patients were relatively high (P<0.05). 【Conclusion】The immune dysfunction degree is negatively correlated with the prognosis of critically ill patients, which will increase the mortality rate. PCT, IL-10, and CD8⁺ can predict the risk of the poor prognosis and mortality.

Key words： Severe Cases/IM Immune Function

收稿日期: 2018-11-06

PACS:

R473

通讯作者: E-mail:810512912@qq.com

引用本文:

陶丹, 李鹏. 动态监测免疫相关指标评估危重症患者免疫功能和病情变化的价值[J]. 医学临床研究, 2020, 37(6): 882-885.
TAO Dan, LI Peng. Dynamic Monitoring of Immune-related Indicators to Assess Immune Function and Predict Disease Severity and Outcome in Critically Ill Patients. JOURNAL OF CLINICAL RESEARCH, 2020, 37(6): 882-885.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2020.06.025 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2020/V37/I6/882

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