脓毒症患儿T淋巴细胞亚群变化与病情严重程度的关系

Correlations between changes in T lymphocyte subsets and disease severity in children with sepsis: a retrospective study

摘要

目的 探讨脓毒症患儿外周血T淋巴细胞亚群及炎症反应与病情严重程度的关系。方法 回顾性收集2018年12月至2021年4月新乡医学院第一附属医院收治的91例脓毒症患儿的临床资料.根据脓毒症患儿的病情严重程度将其分为脓毒症组(62例)、严重脓毒症组(16例)、脓毒症休克组(13例),分析各组间T淋巴细胞亚群、炎症指标的差异,并采用逐步多元无序Logistic回归分析脓毒症病情严重程度的影响因素。结果 三组患儿的住院天数和热峰比较,差异均有统计学意义(H值分别为13.839、15.681,P<0.05);电解质水平:三组间的钙水平比较差异有统计学意义(H=10.557,P<0.05);炎症指标及代谢产物:三组间的降钙素原(PCT)、白介素6(IL-6)、超敏C反应蛋白(CRP)和乳酸水平比较差异均有统计学意义(H值分别为42.554、28.947、25.456、20.769,P<0.05);肝功能:三组间的白蛋白、白球比、总胆红素、谷丙转氨酶、谷草转氨酶、谷氨酰胺转肽酶比较差异均有统计学意义(H值分别为15.438、13.105、13.192、6.261、6.396、10.867,P<0.05);免疫五项:三组间的免疫球蛋白G比较差异有统计学意义(H=6.595,P<0.05);凝血功能:三组间的国际化标准比值、纤维蛋白降解产物和D-二聚体比较差异均有统计学意义(H值分别为14.335、22.992、22.766,P<0.05);淋巴细胞亚群:三组间CD3⁺T淋巴细胞、CD8⁺T淋巴细胞、CD4⁺/CD8⁺T淋巴细胞比值、CD19⁺B淋巴细胞比较差异均有统计学意义(H值分别为37.020、13.162、7.758、13.227,P<0.05).逐步多元无序Logistic回归分析显示:相对于脓毒症组,严重脓毒症组的CD3⁺T淋巴细胞降低、CRP水平升高为严重脓毒症发生的危险因素[OR(95%CI)分别为0.843(0.729~0.975)、1.027(1.004~1.050),P<0.05];相对于脓毒症组,脓毒症休克组的CD3⁺T淋巴细胞降低、CD4⁺/CD8⁺T淋巴细胞比值和CRP水平升高为脓毒症休克发生的危险因素[OR(95%CI)值分别为0.719(0.583~0.886)、6.854(1.071~43.873)、1.031(1.005~1.058),P<0.05]。结论 外周血T淋巴细胞亚群中的CD3⁺T淋巴细胞水平、CD4⁺/CD8⁺T淋巴细胞比值联合超敏C反应蛋白水平变化可以反映脓毒症患儿的病情严重程度.

Abstract

Objective To explore correlations of peripheral blood T-lymphocyte subsets and inflammatory response with disease severity of sepsis in children. Methods Clinical data of 91 children with sepsis who admitted to The First Affiliated Hospital of Xinxiang Medical College from December 2018 to April 2021 were retrospectively analyzed. The children were divided into three groups: sepsis group (62 cases), severe sepsis group (16 cases) and septic shock group (13 cases). T-lymphocyte subsets and inflammatory indexes were tested and compared among the three groups. Multivariate stepwise unordered Logistic regression was used to identify factors influencing sepsis severity. Results There were statistically significant differences in hospitalization length and peak temperature among the three groups (H=13.839 and 15.681 respectively, both P<0.05). For electrolyte levels, there was a statistically significant difference in calcium level among the three groups (H=10.557, P<0.05). For inflammatory indexes and metabolic products, there were statistically significant differences in serum procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP) and lactate levels among the three groups (H=42.554, 28.947, 25.456 and 20.769 respectively, all P<0.05). For liver function, there were statistically significant differences in albumin, albumin to globulin ratio (A/G) ratio, total bilirubin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase among the three groups (H=15.438, 13.105, 13.192, 6.261, 6.396 and 10.867 respectively, all P<0.05). For immune parameters, there was a statistically significant difference in immunoglobulin G among the three groups (H=6.595, P<0.05). For coagulation function, there were statistically significant differences in international normalized ratio, fibrin degradation products, and D-dimer among the three groups (H=14.335, 22.992 and 22.766 respectively, all P<0.05). For lymphocyte subsets, there were statistically significant differences in T lymphocytes CD3 ⁺ and CD8⁺ levels, CD4⁺/CD8⁺ ratio, and B lymphocytes CD19⁺ level among the three groups (H=37.020, 13.162, 7.758 and 13.227 respectively, all P<0.05). Multivariate stepwise unordered Logistic regression analysis showed that compared with the sepsis group, decreased T lymphocyte CD3⁺ level and elevated CRP level in the severe sepsis group were risk factors for severe sepsis [OR(95%CI): 0.843(0.729-0.975) and 1.027(1.004-1.050) respectively, both P<0.05], and compared with the sepsis group, decreased T lymphocytes CD3⁺ level, elevated CD4⁺/CD8⁺ ratio, and elevated CRP level in the septic shock group were risk factors for septic shock [OR(95%CI): 0.719(0.583-0.886), 6.854(1.071-43.873) and 1.031(1.005-1.058) respectively, all P<0.05]. Conclusion The changes in T lymphocyte subsets in peripheral blood, including T lymphocyte CD3⁺ level and CD4⁺/CD8⁺ ratio combined with CRP level can reflect severity of the sepsis in children.

关键词

儿童 / 脓毒症 / T淋巴细胞亚群 / 炎症指标 / 病情严重程度

Key words

children / sepsis / T lymphocyte subset / inflammation index / severity of disease

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基金资助

河南省高等教育教学改革研究与实践立项项目(2021SJGLX455)

河南省医学科技攻关计划联合共建项目(LHGJ20210519)

新乡医学院第一附属医院青年培育基金项目(QNG2022GA17)