标题：合并脓毒性脑病的严重脓毒症患者免疫状态变化的特点

      作者：陆程翔 1，孙德军 1，邱婷 2    (厦门大学附属中山医院重症医学科 1、神经内科 2，福建 厦门 361004)

      卷次： 2018年29卷12期

      【摘要】 目的 探讨合并脓毒性脑病的严重脓毒症患者的免疫状态特点。方法 回顾性分析2014年1月至2017年11月在厦门大学附属中山医院 ICU住院治疗的86例严重脓毒症患者的临床资料，按发生脓毒性脑病与否，将患者分为脓毒性脑病组34例和非脓毒性脑病组52例。分析T淋巴细胞亚群及NK细胞与脓毒性脑病的关系，并与其他相关临床指标进行比较。结果 脓毒性脑病组患者的死亡率为 38.2%，显著高于非脓毒性脑病组的 9.6%,差异有显著统计学意义(P<0.01)；与非脓毒性脑病组比较，脓毒性脑病组患者CD4+T淋巴细胞比例降低[(51.67±7.12)% vs (960.72±3.70)%]、CD4 +/CD8+比值下降[(1.59±0.32) vs (1.85±0.26)]、NK细胞比例增高[(11.80±1.44) vs(9.19±2.36)]，差异均有显著统计学意义(P<0.01)；CD4+T淋巴细胞比例、CD4+/CD8+比值及NK细胞比例与APACHEⅡ评分(r=-0.854、-0.824、0.816，P<0.01)、SOFA评分(r=-0.878、-0.853、0.871，P<0.01)有高度相关性，与特异性神经烯醇化酶(NSE) (r=-0.738、-0.872、0.683，P<0.01)、S-100B蛋白(r=-0.696、-0.719、0.795，P<0.01)也存在较高的相关性。结论 本研究证实合并脓毒性脑病的严重脓毒症患者死亡增高，而免疫失衡是脓毒性脑病的重要特点之一。
      【关键词】 脓毒性脑病；免疫失衡；严重脓毒症；CD4+T淋巴细胞；NK细胞
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2018）12—1664—05

Characteristics of immune status in severe septic patients with septic encephalopathy.
LU Cheng-xiang 1, SUNDe-jun 1, QU Ting 2. Intensive Care Unit 1, Neurological Department 2, Zhongshan Hospital Affiliated to Xiamen University,Xiamen 361004, Fujian, CHINA
【Abstract】 Objective To investigate the characteristics of immune status in severe septic patients with septicencephalopathy (SE). Methods In the current retrospective study, we analyzed the clinical data of 86 patients with se-vere sepsis who were admitted to the Intensive Care Unit from Jan. 2014 to Nov. 2017. The patients were assigned to SE(n=34) and non-SE (n=52) groups according to the occurrence of SE. T-lymphocyte subsets and natural killer (NK) cells,representing the function of cell immune system, were assessed for their relationship with SE, and compared with otherclinical predictors and biomarkers. Results SE group had higher mortality than non-SE group (38.2% vs 9.6% , P=0.01). Univariate analysis indicated lower percentage of CD4 + T-lymphocyte, lower CD4 +/CD8 + ratio, and greater per-centage of NK in the SE group compared with the non-SE group: CD4 + T-lymphocyte (51.67 ± 7.12)% vs (960.72 ±3.70)%, CD4+/CD8+ ratio (1.59±0.32) vs (1.85±0.26), NK (11.80±1.44) vs (9.19±2.36). The percentage of CD4+ T-lym-phocyte, CD4 +/CD8 + ratio, and the percentage of NK cell showed a strong correlation respectively with APACHE Ⅱscores (r=-0.854, -0.824, 0.816, P<0.01; respectively), SOFA scores (r=-0.878, -0.853, 0.871, P<0.01; respectively),neuron-specific enolase (NSE) level (r=-0.738, -0.872, 0.683, P<0.01; respectively) and S-100B protein level(r=-0.696, -0.719, 0.795, P<0.01; respectively). Conclusion Septic encephalopathy implies higher mortality in pa-tients with severe sepsis. Immune imbalance is an important characteristic in patients with septic encephalopathy.
      【Key words】 Septic encephalopathy; Immune imbalance; Severe sepsis; CD4+ T-lymphocytes; Natural killer cell·论 著·doi:10.3969/j.issn.1003-6350.2018.12.012