摘要
目的 探讨CD8+T细胞各亚群在脓毒症诊断的价值.方法 前瞻性选择2021年3月-2022年3月陆军军医大学大坪医院ICU收治的脓毒症和非脓毒症患者各30例作为研究对象.男性40例,女性20例;年龄29～70岁,平均55.4岁.创伤患者16例(包括道路交通伤7例,高处坠落伤5例,挤压伤3例,锐器伤1例).采集患者入ICU后第1、3、5天外周血,用流式细胞仪检测T淋巴细胞及CD8+T细胞各亚群的比例,采用资料测量方差分析比较两组间差异,并采用两组间多重比较方法比较特定时间点两组间差异,单因素Logistic回归分析其与脓毒症发生相关的亚群;受试者工作特征(ROC)曲线评估其对脓毒症的诊断效能;Pearson检验分析其与脓毒症患者严重程度的相关性.结果 脓毒症患者入ICU第1、3、5天的CD3+T淋巴细胞的比例显著低于非脓毒症患者[(54.32±16.44)％vs.(67.13±12.90)％、(59.42±14.49)％vs.(68.12±12.95)％、(58.81±17.47)％vs.(69.68±10.87)％,P 均＜0.05];进一步分析发现脓毒症患者入 ICU第1、3、5天的CD8+效应记忆T细胞亚群的比例也显著低于非脓毒症患者[(25.45±10.55)％vs.(39.51± 12.59)％、(27.38±11.19)％vs.(39.81±14.24)％、(28.56±12.38)％vs.(38.97±12.89)％,P 均＜0.05].此外,脓毒症患者入ICU第3天的CD4+T淋巴细胞及CD8+Naive T细胞亚群的比例显著高于非脓毒症患者[(64.88±10.94)％vs.(57.51±13.49)％、(22.85±17.00)％vs.(14.47±7.32)％,P 均＜0.05];Logistic 回归分析显示CD3+T淋巴细胞比例、CD8+效应记忆T细胞亚群比例、血浆降钙素原(PCT)及CRP水平是患者发生脓毒症的独立危险因素.ROC曲线分析显示,血浆PCT水平与CD8+效应记忆T细胞亚群比例联合诊断脓毒症的ROC曲线下面积(AUC)为0.890(0.775～0.995).结论 CD8+效应记忆T细胞的比例及血浆PCT水平二者联合对脓毒症诊断具有较好的效能.
Abstract
Objective To explore the value of CD8+T cell subsets in the diagnosis of sepsis.Methods A prospective study was conducted on 30 sepsis and 30 non-sepsis patients admitted to the ICU of Daping Hospital,Ar-my Medical University from Mar.2021 to Mar.2022.There are 40 males and 20 females aged 29-70(mean 55.4)years,with 16 trauma patients(7 road traffic injuries,5 falls from height,3 crush injuries,and 1 sharp instrument in-jury).Peripheral blood was sampled on the 1st,3rd,and 5th day of ICU admission and analyzed by flow cytometry to detect the proportions of T lymphocytes and CD8+T cell subsets,respectively naive,memory,and effector T cells(CD8+TCM,CD8+TEM and CD8+Naive T).Comparison between sepsis and non-sepsis patients was performed:repeated measurement data were analyzed using analysis of variance(ANOVA)for repeated measurement data,and specific time point comparisons by multiple comparison methods.Univariate logistic regression analysis was used to identify CD8+T cell subsets that were associated with sepsis occurrence,ROC curves to evaluate their diagnostic ef-ficacy for sepsis,and Pearson correlation test to analyze their correlation with sepsis severity.Results On the 1st,3rd,and 5th day of ICU admission,the proportions of CD3+T cells in sepsis patients were significantly lower than those in non-sepsis patients(54.32％±16.44％vs.67.13％±12.90％,59.42％±14.49％vs.68.12％±12.95％,58.81％±17.47％vs.69.68±10.87％,all P＜0.05);further analysis showed similar results for CD8+TEM(25.45％±10.55％vs.39.51％±12.59％,27.38％±11.19％vs.39.81％±14.24％,28.56％±12.38％vs.38.97±12.89％,all P＜0.05).In addition,the proportions of CD4+T cells and CD8+Naive T in sepsis patients on 3rd day of ICU admission were significantly higher than those in non-sepsis patients(64.88％±10.94％vs.57.51％±13.49％,22.85％±17.00％vs.14.47±7.32％,both P＜0.05).Logistic regression analysis showed that the proportions of CD3+T cells and CD8+TEM subsets,as well as plasma procalcitonin(PCT)and C-reactive pro-tein(CRP)levels were risk factors for sepsis.The AUC of PCT level combined with the proportion of CD8+TEM in the diagnosis of sepsis was 0.890(0.775-0.995).Conclusion The combination of the proportion of CD8+TEM and plasma PCT level has good efficacy in the early diagnosis of sepsis.
基金项目
国家自然科学基金(81971830)
重庆市自然科学基金(cstc2021jcyjmsxmX0445)
创伤、烧伤和复合伤国家重点实验室优青项目(SKLYQ202102)
贵州省科技支撑计划资助([2015]3041)
贵州省危急重病绿色通道建设科技创新人才团队(黔科合平台人才[2017]5654)
NETL
NSTL
维普
万方数据