■要分析CD3+的早期变化,CD4+,脓毒症患者的CD8+T细胞亚群计数及其与预后的相关性,为脓毒症的临床免疫调节提供可行的依据。
■这是一项单中心回顾性研究。该研究招募了7月5日入住吉林大学第一医院重症监护病房的脓毒症患者(符合SEPSIS3.0定义),2018年12月5日,2019年,年龄在18岁或以上。此外,这些患者接受了细胞免疫检测(CD3+,CD4+,CD8+T淋巴细胞计数,和CD4/CD8比值)在ICU入院后24小时内。患者的临床数据,包括年龄,性别,感染部位,APACHEII得分,SOFA得分,ICU住院时间,机械通气时间,ICU死亡率,28天死亡率,收集3年生存状况。比较不同T淋巴细胞亚群计数和CD4+/CD8+比值降低组和未降低组的预后指标和生存期。
■共纳入206名患者,其中76.7%的CD3+T淋巴细胞计数减少,76.7%的人CD4+T淋巴细胞计数下降,和63.6%的CD8+T淋巴细胞计数下降。此外,21.8%的患者CD4+/CD8+比值较低。分析显示CD3+T淋巴细胞计数降低组ICU住院时间较长[11d(4,21)vs.7d(4,17),P=0.03],机械通气百分比增加(67.5%vs.51.0%,P=0.04),和延长机械通气时间[144h(48,360)vs.96小时(48,144),P=0.04]与非降低组相比。与未降低组相比,CD4+/CD8+比值降低组的28天死亡率较高(33.3%vs.25.5%,P=0.29);然而,差异无统计学意义。Logistic回归分析显示CD4+/CD8+比值下降与28天死亡率无显著相关性(P=0.11)。3年随访显示,CD4+/CD8+降低组的生存率低于未降低组(33.3%vs.53.4%,P=0.01)。
■在脓毒症的早期阶段,大多数患者显示CD3+减少,CD4+,和CD8+T细胞亚群,以及CD4+/CD8+比值。CD3+和CD4+/CD8+的降低与一些不良预后有关。
UNASSIGNED: To analyze the early changes in CD3+, CD4+, and CD8+T-cell subset counts in patients with sepsis and their correlation with prognosis to provide a feasible basis for clinical immunomodulation in sepsis.
UNASSIGNED: This is a single-center retrospective
study. The
study enrolled sepsis patients (meeting SEPSIS 3.0 definition) who were admitted to the Department of Intensive Care Unit at the First Hospital of Jilin University from July 5th, 2018 to December 5th, 2019 and were aged 18 years or above. In addition, these patients underwent cellular immune testing (CD3+, CD4+, CD8+ T lymphocyte counts, and CD4+/CD8+ ratio) within 24 hours of ICU admission. Patient\'s clinical data including age, gender, infection site, APACHE II score, SOFA score, length of ICU stay, mechanical ventilation time, ICU mortality, 28-day mortality, and 3-year survival status were collected. The prognostic indicators and survival of the decreased and nondecreased groups of different subsets of T lymphocyte counts and CD4+/CD8+ ratio were compared.
UNASSIGNED: A total of 206 patients were enrolled, with 76.7% having a decrease in CD3+ T lymphocyte count, 76.7% having a decrease in CD4+ T lymphocyte count, and 63.6% having a decrease in CD8+ T lymphocyte count. Furthermore, 21.8% had a lower CD4+/CD8+ ratio. Analysis showed that the CD3+ T lymphocyte count decreased group had a longer length of ICU stay [11 d (4, 21) vs. 7 d (4, 17), P=0.03], increased percentage of mechanical ventilation (67.5% vs. 51.0%, P=0.04), and extended mechanical ventilation time [144 h (48, 360) vs. 96 h (48, 144), P=0.04] compared to the nondecreased group. The 28-day mortality was higher in the decreased group of CD4+/CD8+ ratio compared to the nondecreased group (33.3% vs. 25.5%, P=0.29); however, the difference did not reach statistical significance. Logistic regression analysis revealed no significant correlation between the decrease in CD4+/CD8+ ratio and 28-day mortality (P=0.11). The 3-year follow-up revealed that the CD4+/CD8+ decreased group had a lower survival rate than the nondecreased group (33.3% vs. 53.4%, P=0.01).
UNASSIGNED: In the early stage of sepsis, most patients showed a decrease in CD3+, CD4+, and CD8+T-cell subsets, as well as in the CD4+/CD8+ ratio. The decrease in CD3+ and CD4+/CD8+ was related to some poor prognosis.