摘要目的 探讨细胞免疫功能、炎性因子和心肌酶检测对感染性休克的临床意义及其对预后的评估价值.方法 选择永康市第一人民医院于2015年6月至2018年6月收治的感染性休克患者73例为研究对象,根据患者入ICU后28 d预后情况分为死亡组和生存组.另选择2015年6月至2018年6月健康体检者67例作为对照组.采用美国BD FACSCanto Ⅱ流式细胞仪测定T淋巴细胞亚群变化,包括CD3、CD4、CD8;采用免疫发光分析法测定降钙素原(PCT)含量,采用免疫比浊法测定C反应蛋白( CRP)含量;用酶动力学法测定肌酸激酶MB型(CK-MB)、心肌肌钙蛋白I(cTnI)和乳酸脱氢酶(LDH)含量.结果 生存组和死亡组急性生理学及慢性健康状况评分( APACHE Ⅱ评分)和多器官功能障碍综合征评分( MODS评分)高于对照组[(2.20 ± 0.61)分和(4.86 ± 1.29)分],且死亡组 APACHE Ⅱ评分[( 16.45 ± 4.28 )分]和 MODS 评分(27.63 ± 4.97)分]高于生存组[(9.84 ± 2.45)分和(19.84 ± 3.28)分],差异均有统计学意义(均P＜0.05).生存组和死亡组CD+3 、 CD+4 和 CD+4 /CD+8 低于对照组[( 71.32 ± 6.96 )%、 ( 42.63 ± 4.26 )%和( 1.67 ± 0.31)%]而CD+8 高于对照组[( 25.49 ± 2.64 )%],且死亡组 CD+3 [(50.91 ± 3.28)%]、 CD+4 [(31.02 ± 2.18)%]和 CD+4 /CD+8 [(0.96 ± 0.14)%]低于生存组[(59.39 ± 4.35)%、(36.84 ± 2.97)%和(1.26 ± 0.23)],而CD+8 [(32.26 ± 2.07)%]高于生存组[(29.13 ± 1.86)%],差异均有统计学意义(均P＜0.05).生存组和死亡组PCT和CRP含量高于对照组[(0.19 ± 0.03)ng/mL和(2.19 ± 0.76) mg/L],且死亡组PCT [(15.93 ± 3.26)ng/mL]和CRP[(184.32 ± 29.80)mg/L]含量高于生存组[(6.87 ± 1.94)ng/mL和(69.49 ± 17.42)mg/L],差异均有统计学意义(均P＜0.05).感染性休克生存组和死亡组CK-MB含量低于对照组[(1.97 ± 0.21)μg/L]而cTnI和LDH含量高于对照组[(0.03 ± 0.01)μg/L和(168.93 ± 16.52)U/L],且死亡组CK-MB[(0.68 ± 0.10)μg/L]含量低于生存组[(1.27 ± 0.13μg/L)]而cTnI[(0.39 ± 0.06) μg/L]和LDH [(384.52 ± 39.89)U/L]含量低于生存组[(0.17 ± 0.04)μg/L和(257.18 ± 25.47) U/L],差异均有统计学意义(均P＜0.05).结论 感染性休克患者免疫功能明显降低,存在明显炎性反应和心肌酶异常,检测细胞免疫功能、炎性因子和心肌酶可作为判断感染性休克有效指标.

abstractsObjective To investigate the clinical significance of cellular immune function, inflammatory factors and myocardial enzyme detection in evaluation of prognosis of septic shock,so as to provide a reference for clinical diagnosis and treatment of septic shock.Methods From June 2015 to June 2018,73 patients with septic shock treated in the First People＇s Hospital of Yongkang were selected as the research subjects.According to the 28d prognosis after the patients entered the ICU,the patients were divided into the death group and the survival group. Another 67 cases of health examination from June 2015 to June 2018 were selected as control group.The changes of T lymphocyte subsets includingCD3,CD4 and CD8 were measured by BD FACSCanto I I flow cytometry,the content of procalcitonin(PCT) was determined by immunoluminescence assay,the content of C -reactive protein(CRP) was determined by immunoturbidimetry,and the content of creatine kinase MB(CK-MB),cardiac troponin I(cTnI) and lactate dehydrogenase(LDH) was determined by enzymatic kinetics. Results The APACHE Ⅱ score and MODS score of the survival group and the death group were higher than those of the control group [(2.20 ± 0.61)points and (4.86 ± 1. 29 ) points]. The APACHE Ⅱ score and MODS score of death group [(16. 45 ± 4. 28) points and (27.63 ± 4.97)points] were higher than those of survival group [(9.84 ± 2.45)points and (19.84 ± 3.28)points] (all P＜0.05).The CD+3 ,CD+4 and CD+4 /CD+8 in the survival group and the death group were significantly lower than those in the control group[(71.32 ± 6.96)%,(42.63 ± 4.26)%,(1.67 ± 0.31)%] ( all P＜0.05).The contents of PCT and CRP in the survival group and the death group were higher than those in the control group [(0.19 ± 0.03) ng/mL and (2.19 ± 0.76)mg/L],and the contents of PCT [(15.93 ± 3.26) ng/mL] and CRP [(184.32 ± 29.80)mg/L] in the death group were higher than those in the survival group [(6.87 ± 1.94)ng/mL and (69.49 ± 17.42)mg/L] (all P＜0.05).The CK-MB content in the survival group and the death group of septic shock was lower than that in the control group [(1.97 ± 0.21)μg/L],and the cTnI and LDH contents were higher than that in the control group [(0.03 ± 0.01)μg/L and (168.93 ± 16.52) U/L],the content of CK-MB [(0.68 ± 0.10)μg/L] in the death group was lower than that in the survival group [(1.27 ± 0.13)μg/L],while the contents of cTnI [(0.39 ± 0.06)μg/L] and LDH [(384.52 ± 39.89)U/L] in the death group were lower than those in the survival group [(0.17 ± 0.04) μg/L and (257.18 ± 25.47) U/L] ( P ＜0.05). Conclusion The immune function of the patients with septic shock is obviously reduced,there are obvious inflammatory reactions and abnormal myocardial enzymes, and the detection of cellular immune function, inflammatory factors and myocardial enzymes can be used as an effective index to judge the shock of septic shock.