脓毒症休克患者免疫细胞变化与疾病演变及预后关系的研究_Chinese Journal of Respiratory and Critical Care Medicine

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李文亮 , 张锦

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脓毒症休克; 致炎细胞; 预后

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目的评价脓毒症休克患者外周血中性粒细胞、单核细胞、淋巴细胞计数与多器官功能衰竭及预后的关系。方法记录患者被诊断为脓毒症休克后第1、3、5、7 d 中性粒细胞、单核细胞、淋巴细胞的变化, 同时进行脓毒症相关性器官衰竭评分( SOFA) 。根据院内预后分为存活组和死亡组。结果 100 例持续存在7 d 以上脓毒症休克的患者中, 50 例存活,50 例死亡。死亡组单核细胞计数、SOFA 评分在第5、7 d 明显升高, 并显著高于存活组的对应值( P lt;0. 05) 。死亡组淋巴细胞计数在第5、7 d 明显降低, 并低于存活组的对应值( P lt;0. 05) 。两组外周血中性粒细胞计数均未发生明显变化( P gt;0. 05) 。结论脓毒症休克时, 单核细胞凋亡可能是机体的保护机制, 而淋巴细胞计数呈下降趋势预示患者预后不良。将SOFA 评分与淋巴细胞计数的变化相结合观察脓毒症休克的病情, 对患者的治疗及预后的评价有指导意义。

Citation： 李文亮,张锦. 脓毒症休克患者免疫细胞变化与疾病演变及预后关系的研究. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(4): 430-432. doi: Copy

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7.	蒋贤高, 汪晓波, 王仁数. 脓毒血症患者监测血清降钙素原、C 反应蛋白的临床意义. 中国呼吸与危重监护杂志, 2009, 8: 429 -431.
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1. Farand P, Hamel M, Lauzier F, et al. Organ perfusion/permeabilityrelated effects of norepinephrine and vasopressin in sepsis. Crit Care Med, 2006, 34: 1647-1653.
2. 林洪远. 脓毒症的免疫调理治疗. 中国医师进修杂志, 2006,29: 8-10.
3. Giamarellos-Bourboulis EJ, Routsi C, Plachouras D, et al. Early apoptosis of blood monocytes in the septic host: is it a mechanism of protection in the event of septic shock? Critical Care, 2006, 10: R76 -R83.
4. Le Tulzo Y, Pangault C, Gacouin A, et al. Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock, 2002 , 18: 487-494.
5. Felmet KA, Hall MW, Clark RS, et al. Prolonged lymphopenia,lymphoid depletion, and hypoprolactinemia in children with nosocomial sepsis and multiple 0rgan failure. J Immunol, 2005, 174 :3765-3772.
6. 杜斌, 陈德昌, 刘大为, 等. 感染相关的器官衰竭评分对多器官功能障碍综合征预后判断的意义. 中华医学杂志, 2001, 81: 78 -81 .
7. 蒋贤高, 汪晓波, 王仁数. 脓毒血症患者监测血清降钙素原、C 反应蛋白的临床意义. 中国呼吸与危重监护杂志, 2009, 8: 429 -431.
8. Kox WJ, Volk T, Kox SN, et al. Immunomodulatory therapies in sepsis. Intensive Care Med, 2000, 26: S124-S128.

Chinese Journal of Respiratory and Critical Care Medicine

脓毒症休克患者免疫细胞变化与疾病演变及预后关系的研究

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