氧合指数联合T细胞亚群计数判断流感相关脓毒症患者预后的临床价值

doi:10.3969/j.issn.1002-1949.2019.05.011

摘要
图/表
参考文献(24)
相关文章 (15)

全文: PDF (727 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的本研究旨在通过氧合指数和T细胞亚群绝对计数，并结合其他有效临床指标判断流感相关脓毒症患者的预后。方法回顾性研究2013~2018年在首都医科大学附属北京朝阳医院经急诊科或发热门诊收治入院的流感相关脓毒症患者，以28 d死亡为研究终点，分为存活组和死亡组，比较分析两组间临床特征的差异，并回归分析死亡的独立预测因素。模型的预测能力用受试者操作特征(ROC)曲线下面积(AUC)评价。结果最终129例患者被纳入此项研究，其中28 d存活组101例(78%)，28 d死亡组28例(22%)。死亡组年龄（中位数，四分位数）64(51,72)高于存活组［57(44,66)，P=0.086］；死亡组格拉斯哥昏迷评分（GCS）(9.5±5.0)分低于存活组［（12.2±4.1）分，P=0.012］；死亡组CD4+T淋巴细胞计数（297±235）×106/L低于存活组［（453±355）×106/L，P=0.008］；死亡组CD8+T淋巴细胞计数（156±112）×106/L低于存活组［（259±181）×106/L，P=0.001］；死亡组氧合指数187.5±49.7低于存活组（255.6±99.9，P<0.001）。多变量Logistic回归分析得出年龄、GCS评分、氧合指数和CD8+T淋巴细胞计数是预测流感相关脓毒症患者死亡的独立指标，其OR值［95%置信区间(confidence interval，CI）］分别是1.041（95%CI 1.006~1.078）、0.902（95%CI 0.813~1.000）、0.986（95%CI0.978~0.995）和0.995（95%CI0.991~1.000）。联合预测值的AUC 0.820(95%CI0.739~0.901)大于SOFA评分的AUC 0.726(95%CI 0.617~0.835，Z=1.681, P=0.09）。结论年龄、GCS评分、氧合指数和CD8+T淋巴细胞计数联合评价能够预测流感相关脓毒症患者的死亡风险。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	腾飞
	梅雪
	郭树彬

关键词 ：流感, 脓毒症, 氧合指数, T细胞亚群, 急诊

通讯作者: 郭树彬（1963-），男，博士，主任医师，教授，博士生导师，急诊科主任，E-mail：shubinguo@126.com。

作者简介: 腾飞（1983-），男，硕士，主治医师，E-mail：tengfei.vip@live.cn。

引用本文:

腾飞,梅雪,郭树彬. 氧合指数联合T细胞亚群计数判断流感相关脓毒症患者预后的临床价值[J]. 中国急救医学, 2019, 39(5): 452-456.
Teng Fei, Mei Xue, Guo Shu-Bin. Clinical value of oxygenation index combined with T cell subsets count in predicting prognosis of patients with influenza-associated sepsis. Chinese Journal of Critical Care Medicine, 2019, 39(5): 452-456.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.05.011 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I5/452

［1］Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study［J］. Lancet, 2018, 391 (10 127):1285-1300. ［2］Sullivan S. Challenges in reducing influenza-associated mortality［J］. Lancet, 2018, 391(10 127):1242-1244. ［3］Fujikura Y, Kawano S, Kouzaki Y, et al. Mortality and severity evaluation by routine pneumonia prediction models among Japanese patients with 2009 pandemic influenza A (H1N1) pneumonia［J］. Respir Investig, 2014, 52(5): 280-287. ［4］Greenbaum JA, Kotturi MF, Kim Y, et al. Pre-existing immunity against swine-origin H1N1 influenza viruses in the general human population［J］. Proc Natl Acad Sci U S A, 2009, 106(48):20 365-20 370. ［5］Hartman H， Wetterholm E， Thorlacius H， et al. Histone deacetylase regulates trypsin activation，inflammation，and tissue damage in acute pancreatitis in mice［J］. Dig Dis Sci, 2015, 60(5):1284-1289. ［6］国家卫生和计划生育委员会，国家中医药管理局.流行性感冒诊疗方案(2018年版) ［J］.中国感染控制杂志, 2018, 17(2):181-184. ［7］Cohen J, Vincent JL, Adhikari NK, et al. Sepsis: a roadmap for future research［J］. Lancet Infect Dis, 2015, 15(5):581-614. ［8］Freund Y, Lemachatti N, Krastinova E, et al. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department［J］. JAMA, 2017, 317(3):301-308.  ［9］Chaves SS, Aragon D, Bennett N, et al. Patients hospitalized with laboratory-confirmed influenza during the 2010-2011 influenza season: exploring disease severity by virus type and subtype［J］. J Infect Dis, 2013, 208(8):1305-1314. ［10］Cummings MJ, Tokarz R，Bakamutumaho B, et al. Epidemiologic and spatiotemporal characterization of influenza and severe acute respiratory infection in Uganda ［J］. Ann Am Thorac Soc, 2016, 13(12):2159-2168. ［11］中国医师协会呼吸医师分会.合理应用抗流行性感冒病毒药物治疗流行性感冒专家共识(2016年) ［J］.中华内科杂志, 2016, 55(3): 244-248.  ［12］Neff-LaFord HD, Vorderstrasse BA, Lawrence B. Fewer CTL, not enhanced NK cells, are sufficient for viral clearance from the lungs of immunocompromised mice［J］. Cell Immunol, 2003, 226（1）:54-64.  ［13］王宗义，胡爱荣，蒋素文，等. 轻症和重症甲型 H1 N1流感患者免疫学特征比较分析［J］. 中华微生物学和免疫学杂志, 2013, 33(9):673-676. ［14］黄燕，罗二平，黄小平，等. 人感染H7N9禽流感患者外周血T淋巴细胞亚群和细胞因子的变化及其临床意义［J］. 中华传染病杂志, 2017, 35(2):79-82. ［15］Inoue S, Bo L, Bian J, et al. Dose-dependent effect of anti-CTLA-4 on survival in sepsis［J］. Shock， 2011, 36(1):38-44. ［16］栾樱译，秦庆华，吕奔,等. 调节性Ｔ细胞对脓毒症中Ｔ淋巴细胞凋亡的影响［J］. 临床急诊杂志, 2016, 18(8):585-589. ［17］Hernandez-Vargas EA, Wilk E, Canini L, et al. Effects of aging on influenza virus infection dynamics［J］. J Virol， 2014， 88(8):4123-4131.  ［18］Ranieri V, Rubenfeld GD, Thompson B, et al. Acute respiratory distress syndrome: the Berlin definition［J］. JAMA, 2012, 307（23）: 2526-2533. ［19］Bjarnason A, Thorleifsdottir G, L ve A, et al. Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study［J］. PLoS One, 2012, 7(10):e46 816.  ［20］Ho YC, Wang JL, Wang JT, et al. Prognostic factors for fatal adult influenza pneumonia［J］. J Infect, 2009, 58（6）:439-445. ［21］Shi SJ, Li H, Liu M, et al. Mortality prediction to hospitalized patients with influenza pneumonia: PO2/FiO2 combined lymphocyte count is the answer［J］. Clin Respir J, 2017, 11(3):352-360.  ［22］Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) ［J］. JAMA, 2016, 315(8):762-774.  ［23］Cao B, Li XW, Mao Y, et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China［J］. N Engl J Med, 2009, 361(26):2507-2517.  ［24］Abraham E, Singer M. Mechanisms of sepsis-induced organ dysfunction［J］. Crit Care Med, 2007, 35(10):2408-2416.