本文選題：急危重癥 + 淋巴細胞亞群��； 參考：《皖南醫(yī)學院》2015年碩士論文

【摘要】：目的:觀察急危重癥患者淋巴細胞亞群以及總蛋白(Total Protein,TP)、白蛋白(Albumin,ALB)、球蛋白(Globulin,GLOB)、C反應蛋白(C-reactive Protein,CRP)的變化,了解急危重病患者的免疫功能狀態(tài),為臨床診治各種急危重癥提供理論依據(jù)。方法:收集2013年9月-2015年2月在弋磯山醫(yī)院住院的急危重癥患者116例,篩選符合標準的急危重癥患者72例(危重癥組),同時選取來自我院體檢中心的健康人群44例(對照組)。入院24小時(Hour,h)內(nèi)抽取患者靜脈血,用流式細胞術定量分析淋巴細胞亞群,包括CD3+T細胞、CD4+T細胞、CD3+CD8+T細胞、CD3-CD16+56+細胞、CD3-CD19+細胞百分數(shù)和CD4+/CD8+比值;并于入院第2天(Day,d)空腹抽取靜脈血行生化檢測,檢測患者各項指標,并與健康人群進行比較。應用SPSS 17.0進行統(tǒng)計分析。結(jié)果:急危重癥病人外周血CD3+T、CD3+CD4+T、CD3-CD19+細胞百分數(shù)、CD4+/CD8+比值與健康人群比較降低[(56.63±6.19)%與(69.84±4.82)%、(29.23±4.25)%與(35.55±4.88)%、(12.40±3.35)%與(15.13±2.79)%、(1.30±0.33)與(1.50±0.34)],CD8+T細胞百分數(shù)升高[(26.91±5.70)%與(24.50±4.22)%],差異有統(tǒng)計學意義(P0.05),兩組患者外周血CD3-CD16+56+百分數(shù)差異無統(tǒng)計學意義(P0.05)。急危重癥病人血清CRP濃度高于健康人群[(80.52±17.76)mg/L與(0.47±0.08)mg/L],差異有顯著統(tǒng)計學意義(P0.01),TP、ALB、GLOB濃度低于健康人群[(53.74±5.48)g/L與(75.02±4.14)g/L、(28.09±3.95)g/L與(46.87±3.13)g/L、(25.74±3.65)g/L與(27.97±2.91)g/L],差異有統(tǒng)計學意義(P0.05)。入選的72例急危重癥病人,根據(jù)入院后28d死亡與否分為存活組36例,死亡組36例。死亡組患者外周血CD3+T、CD3+CD4+T以及CD3-CD19+細胞百分數(shù)均低于存活組患者[(53.41±4.84)%與(59.85±5.73)%、(27.93±3.76)%與(30.52±4.38)%、(11.14±3.31)%與(13.67±2.93)%],差異具有統(tǒng)計學意義(P0.05),兩組患者外周血CD8+T、CD3-CD16+56+細胞百分數(shù)、CD4+/CD8+比值差異無統(tǒng)計學意義(P0.05),死亡組患者血清CRP濃度高于存活組[(93.69±9.98)mg/L與(66.22±9.58)mg/L],TP、ALB濃度低于存活組[(51.86±4.85)g/L與(55.63±5.47)g/L、(26.83±3.17)g/L與(29.91±3.07)g/L],差異具有統(tǒng)計學意義(P0.05),兩組患者血清GLOB濃度差異無統(tǒng)計學意義(P0.05)。相關性分析結(jié)果:CD3+T淋巴細胞百分比與CRP水平呈負相關(r=-0.544,P=0.000)。ROC曲線顯示CD3+、CD3+CD4+、CD3-CD19+淋巴細胞百分數(shù)以及血清CRP、TP、ALB濃度能夠預測急危重癥患者的預后,曲線下面積(AUC)分別為0.807、0.619、0.717、0.970、0.693、0.738。結(jié)論:1.急危重癥患者外周血CD3+、CD4+、CD3-CD19+淋巴細胞百分數(shù)、CD4+/CD8+比值降低,CD8+T細胞百分數(shù)升高,提示患者存在細胞免疫功能紊亂。2.患者血清總蛋白及白蛋白濃度低,C反應蛋白濃度明顯升高,提示患者體液免疫功能紊亂。3.CD3+T淋巴細胞百分比與CRP水平呈負相關。4.外周血CD3+T、CD3+CD4+T、CD3-CD19+細胞百分數(shù)以及血清CRP、TP、ALB濃度對于急危重癥病人的預后有一定的意義。其中,ROC曲線分析得到CRP的最佳界值點為85.15mg/ml,CD3+淋巴細胞百分數(shù)的最佳界值點為56.4%。
[Abstract]:Objective: To observe the changes of lymphocyte subsets and Total Protein (TP), albumin (Albumin, ALB), Globulin (GLOB), Globulin (GLOB), C reactive protein (C-reactive Protein, CRP), to understand the immune function state of patients with acute and severe disease, and to provide a theoretical basis for clinical diagnosis and treatment of acute critically ill patients. Methods: 9 in 2013. 116 acute critically ill patients hospitalized at Yi San Shan Hospital in February, -2015, were selected to select 72 cases of critical critically ill patients (critical group), and 44 healthy people from the physical examination center of our hospital (control group) were selected. The venous blood was extracted from the hospital for 24 hours (Hour, H), and the lymphocyte subgroups were quantitatively analyzed by flow cytometry, including CD3. +T cells, CD4+T cells, CD3+CD8+T cells, CD3-CD16+56+ cells, the percentage of CD3-CD19+ cells and the ratio of CD4+/CD8+, and the biochemical detection of venous blood from the empty stomach on the second day (Day, d) on the hospital. The indexes of the patients were detected and compared with those of the healthy population. The statistical analysis was carried out with SPSS 17. The results were: CD3+T, CD3+CD4 in peripheral blood of acute critically ill patients. The percentage of +T, CD3-CD19+ cells, and the ratio of CD4+/CD8+ to healthy people were lower [(56.63 + 6.19)% and (69.84 + 4.82)%, (29.23 + 4.25)% and (35.55 + 4.88)%, (12.40 + 3.35)% and (15.13 + 2.79)%, (1.30 +%) and (4.25)%), and the difference was statistically significant (P0.05), and the difference was statistically significant (P0.05). There was no significant difference in the percentage of CD3-CD16+56+ in peripheral blood (P0.05). The serum CRP concentration in acute critical patients was higher than that of healthy people [(80.52 + 17.76) mg/L and (0.47 + 0.08) mg/L], the difference was statistically significant (P0.01), TP, ALB, GLOB concentration was lower than that of healthy people [(53.74 + 5.48) g/L and (75.02 + 4.14) g/L, (28.09 + 3.95) g/L and (46.87 + 3.13)) /L, (25.74 + 3.65) g/L and (27.97 + 2.91) g/L], the difference was statistically significant (P0.05). 72 patients with acute critical illness were divided into 36 cases of survival and 36 cases in the death group. The percentage of CD3+T, CD3+CD4+T and CD3-CD19+ cells in the peripheral blood of the death group were lower than those of the survival group [(53.41 + 4.84)% and (59.85 +)% (59.85 + 5.73)%, (2) (2). 7.93 + 3.76% and (30.52 + 4.38)%, (11.14 + 3.31)% and (13.67 + 2.93)%], the difference was statistically significant (P0.05). There was no significant difference in the percentage of CD8+T, CD3-CD16+56+ cells in the peripheral blood of the two groups and the ratio of CD4+/CD8+ (P0.05). The serum CRP concentration in the death group was higher than that of the survival group [(93.69 + 9.98) mg/L and (66.22 + 9.58) mg/L], TP, ALB concentration Lower than survival group [(51.86 + 4.85) g/L and (55.63 + 5.47) g/L, (26.83 + 3.17) g/L and (29.91 + 3.07) g/L], the difference was statistically significant (P0.05). The difference of serum GLOB concentration in the two groups was not statistically significant (P0.05). The correlation analysis showed that the percentage of CD3+T lymphocytes was negatively correlated with the level of CRP (r=-0.544, P=0.000).ROC curves showed The percentage of CD4+, CD3-CD19+ lymphocyte and serum CRP, TP, and ALB can predict the prognosis of patients with acute severe disease. The area under the curve (AUC) is 0.807,0.619,0.717,0.970,0.693,0.738. conclusion, respectively: 1. the percentage of CD3+, CD4+, CD3-CD19+ lymphocytes, CD4+/CD8+ ratio, and the increase of CD8+T cell percentage in peripheral blood of acute critically ill patients. The serum total protein and albumin concentration in patients with cellular immune dysfunction.2. was low, and the concentration of C reactive protein increased significantly. The percentage of.3.CD3+T lymphocyte in the patient's humoral immune dysfunction was negatively correlated with CD3+T in.4. peripheral blood, CD3+CD4+T, CD3-CD19+ cell percentage and serum CRP, TP, ALB concentration in acute risk. The prognosis of severe patients has certain significance. Among them, the best boundary value point of CRP is 85.15mg/ml, and the best boundary point of the percentage of CD3+ lymphocyte is 56.4%. with the ROC curve analysis.

【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.7

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