目的 探讨外周血淋巴细胞计数、淋巴细胞比例在非感染性全身炎症反应综合征(SIRS)、脓毒症及严重脓毒症患者中的变化及意义.方法 回顾分析201 1年1月至2013年9月入住北京大学第三医院急诊科重症监护病房(ICU)423例患者的临床资料,其中非感染性SIRS患者54例,脓毒症患者177例,严重脓毒症患者192例；死亡150例,存活273例.入院时检测外周血白细胞计数(WBC)、中性粒细胞比例(N)、淋巴细胞计数、淋巴细胞比例、乳酸、血清超敏C-反应蛋白(hs-CRP)和降钙素原(PCT)水平,并计算急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分.根据患者诊断和预后分组,比较各指标,并采用Spearman相关分析评价淋巴细胞与各指标的相关性.结果 年龄越大,病情越重.在SIRS组、脓毒症组及严重脓毒症组,随病情加重,APACHEⅡ评分(分:7.78±3.72、13.85±7.22、24.00±9.79)、住院时间[d:6.0(1.0,9.0)、12.0(8.0,22.0)、19.5(7.0,29.0)]、病死率(0、10.2％、52.6％)、WBC(×109/L:7.59±3.27、8.94±3.95、10.32±5.50)、N(0.685±0.132、0.778±0.135、0.831±0.086)、hs-CRP[mg/L:4.60(2.80,7.52)、23.58(13.49,49.22)、59.77(19.36,110.62)和PCT[μg/L:0.05(0.05,0.05)、0.09(0.05,0.61)、0.63(0.10,5.25)]呈升高趋势(均P=0.000),淋巴细胞计数[×109/L:1.53 (0.89,1.88)、0.90 (0.65,1.42)、0.80 (0.50,1.12)]、淋巴细胞比例(0.225±0.122、0.138±0.097、0.106±0.070)呈降低趋势(P＜0.05和P＜0.01)；3组乳酸水平比较差异有统计学意义[分别为2.40(1.30,5.10)、1.10(0.80,2.00)、1.40(1.00,2.50)mmol/L,P=0.000].与存活组比较,死亡组年龄(岁:76.71±12.21比73.21±14.49)、APACHEⅡ评分(分:24.69±9.58比13.91±8.41)、住院时间[d:12.0(4.0,28.0)比11.0(8.0,22.0)]、WBC(×109/L:10.29±5.82比8.89±3.98)、N(0.809±0.130比0.776±0.120)、乳酸[mmol/L:1.80(1.10,2.90)比1.30(0.90,2.49)]、hs-CRP[mg/L:50.94(19.21,97.13)比21.71 (6.39,54.40)和PCT[μg/L:0.74 (0.13,5.83)比0.08(0.05,0.59)]明显升高(P＜0.05或P＜0.01),淋巴细胞计数[×109/L:0.90(0.50,1.29)比1.05 (0.70,1.54)]、淋巴细胞比例(0.123±0.098比0.143±0.097)明显降低((P＜0.01和P＜0.05).淋巴细胞计数与N(r=-0.597,P=0.000)、hs-CRP(r=-0.298,P=0.000)、PCT(r=-0.304,P=0.000)和APACHEⅡ评分(r=-0.214,P=0.000)呈明显负相关,与淋巴细胞比例呈明显正相关(r=0.691,P=0.000),与WBC(r=0.082,P=0.0910),乳酸(r=0.073,P=0.132)无相关性.结论 淋巴细胞水平与脓毒症的严重程度相关,监测其水平变化可作为脓毒症患者病情评估及治疗效果的辅助指标之一.
目的 探討外週血淋巴細胞計數、淋巴細胞比例在非感染性全身炎癥反應綜閤徵(SIRS)、膿毒癥及嚴重膿毒癥患者中的變化及意義.方法 迴顧分析201 1年1月至2013年9月入住北京大學第三醫院急診科重癥鑑護病房(ICU)423例患者的臨床資料,其中非感染性SIRS患者54例,膿毒癥患者177例,嚴重膿毒癥患者192例；死亡150例,存活273例.入院時檢測外週血白細胞計數(WBC)、中性粒細胞比例(N)、淋巴細胞計數、淋巴細胞比例、乳痠、血清超敏C-反應蛋白(hs-CRP)和降鈣素原(PCT)水平,併計算急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分.根據患者診斷和預後分組,比較各指標,併採用Spearman相關分析評價淋巴細胞與各指標的相關性.結果 年齡越大,病情越重.在SIRS組、膿毒癥組及嚴重膿毒癥組,隨病情加重,APACHEⅡ評分(分:7.78±3.72、13.85±7.22、24.00±9.79)、住院時間[d:6.0(1.0,9.0)、12.0(8.0,22.0)、19.5(7.0,29.0)]、病死率(0、10.2％、52.6％)、WBC(×109/L:7.59±3.27、8.94±3.95、10.32±5.50)、N(0.685±0.132、0.778±0.135、0.831±0.086)、hs-CRP[mg/L:4.60(2.80,7.52)、23.58(13.49,49.22)、59.77(19.36,110.62)和PCT[μg/L:0.05(0.05,0.05)、0.09(0.05,0.61)、0.63(0.10,5.25)]呈升高趨勢(均P=0.000),淋巴細胞計數[×109/L:1.53 (0.89,1.88)、0.90 (0.65,1.42)、0.80 (0.50,1.12)]、淋巴細胞比例(0.225±0.122、0.138±0.097、0.106±0.070)呈降低趨勢(P＜0.05和P＜0.01)；3組乳痠水平比較差異有統計學意義[分彆為2.40(1.30,5.10)、1.10(0.80,2.00)、1.40(1.00,2.50)mmol/L,P=0.000].與存活組比較,死亡組年齡(歲:76.71±12.21比73.21±14.49)、APACHEⅡ評分(分:24.69±9.58比13.91±8.41)、住院時間[d:12.0(4.0,28.0)比11.0(8.0,22.0)]、WBC(×109/L:10.29±5.82比8.89±3.98)、N(0.809±0.130比0.776±0.120)、乳痠[mmol/L:1.80(1.10,2.90)比1.30(0.90,2.49)]、hs-CRP[mg/L:50.94(19.21,97.13)比21.71 (6.39,54.40)和PCT[μg/L:0.74 (0.13,5.83)比0.08(0.05,0.59)]明顯升高(P＜0.05或P＜0.01),淋巴細胞計數[×109/L:0.90(0.50,1.29)比1.05 (0.70,1.54)]、淋巴細胞比例(0.123±0.098比0.143±0.097)明顯降低((P＜0.01和P＜0.05).淋巴細胞計數與N(r=-0.597,P=0.000)、hs-CRP(r=-0.298,P=0.000)、PCT(r=-0.304,P=0.000)和APACHEⅡ評分(r=-0.214,P=0.000)呈明顯負相關,與淋巴細胞比例呈明顯正相關(r=0.691,P=0.000),與WBC(r=0.082,P=0.0910),乳痠(r=0.073,P=0.132)無相關性.結論 淋巴細胞水平與膿毒癥的嚴重程度相關,鑑測其水平變化可作為膿毒癥患者病情評估及治療效果的輔助指標之一.
목적 탐토외주혈림파세포계수、림파세포비례재비감염성전신염증반응종합정(SIRS)、농독증급엄중농독증환자중적변화급의의.방법 회고분석201 1년1월지2013년9월입주북경대학제삼의원급진과중증감호병방(ICU)423례환자적림상자료,기중비감염성SIRS환자54례,농독증환자177례,엄중농독증환자192례；사망150례,존활273례.입원시검측외주혈백세포계수(WBC)、중성립세포비례(N)、림파세포계수、림파세포비례、유산、혈청초민C-반응단백(hs-CRP)화강개소원(PCT)수평,병계산급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분.근거환자진단화예후분조,비교각지표,병채용Spearman상관분석평개림파세포여각지표적상관성.결과 년령월대,병정월중.재SIRS조、농독증조급엄중농독증조,수병정가중,APACHEⅡ평분(분:7.78±3.72、13.85±7.22、24.00±9.79)、주원시간[d:6.0(1.0,9.0)、12.0(8.0,22.0)、19.5(7.0,29.0)]、병사솔(0、10.2％、52.6％)、WBC(×109/L:7.59±3.27、8.94±3.95、10.32±5.50)、N(0.685±0.132、0.778±0.135、0.831±0.086)、hs-CRP[mg/L:4.60(2.80,7.52)、23.58(13.49,49.22)、59.77(19.36,110.62)화PCT[μg/L:0.05(0.05,0.05)、0.09(0.05,0.61)、0.63(0.10,5.25)]정승고추세(균P=0.000),림파세포계수[×109/L:1.53 (0.89,1.88)、0.90 (0.65,1.42)、0.80 (0.50,1.12)]、림파세포비례(0.225±0.122、0.138±0.097、0.106±0.070)정강저추세(P＜0.05화P＜0.01)；3조유산수평비교차이유통계학의의[분별위2.40(1.30,5.10)、1.10(0.80,2.00)、1.40(1.00,2.50)mmol/L,P=0.000].여존활조비교,사망조년령(세:76.71±12.21비73.21±14.49)、APACHEⅡ평분(분:24.69±9.58비13.91±8.41)、주원시간[d:12.0(4.0,28.0)비11.0(8.0,22.0)]、WBC(×109/L:10.29±5.82비8.89±3.98)、N(0.809±0.130비0.776±0.120)、유산[mmol/L:1.80(1.10,2.90)비1.30(0.90,2.49)]、hs-CRP[mg/L:50.94(19.21,97.13)비21.71 (6.39,54.40)화PCT[μg/L:0.74 (0.13,5.83)비0.08(0.05,0.59)]명현승고(P＜0.05혹P＜0.01),림파세포계수[×109/L:0.90(0.50,1.29)비1.05 (0.70,1.54)]、림파세포비례(0.123±0.098비0.143±0.097)명현강저((P＜0.01화P＜0.05).림파세포계수여N(r=-0.597,P=0.000)、hs-CRP(r=-0.298,P=0.000)、PCT(r=-0.304,P=0.000)화APACHEⅡ평분(r=-0.214,P=0.000)정명현부상관,여림파세포비례정명현정상관(r=0.691,P=0.000),여WBC(r=0.082,P=0.0910),유산(r=0.073,P=0.132)무상관성.결론 림파세포수평여농독증적엄중정도상관,감측기수평변화가작위농독증환자병정평고급치료효과적보조지표지일.
Objective To investigate the change in blood lymphocyte levels and lymphocyte percentage in critical patients,including those with non-infectious systemic inflammatory response syndrome (SIRS),sepsis and severe sepsis.Methods Clinical data of 423 patients admitted to intensive care unit (ICU) of Department of Emergency of Peking University Third Hospital from January 2011 to September 2013 were retrospectively analyzed.Among these patients,there were 54 with non-infectious SIRS,177 with sepsis and 192 with severe sepsis.150 of them died,and 273 survived.The white blood count (WBC),neutrophil (N),lymphocyte count,lymphocyte percentage,lactic acid,serum high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) were determined at admission,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was estimated.The patients were divided into different groups according to diagnosis and prognosis to compare the value of the indexes,and the correlation between lymphocyte count and other markers were analyzed by Spearman relative analysis.Results The older the patients,the more severe the disease.In the non-infective SIRS,sepsis and severe sepsis groups,APACHE Ⅱ scores (7.78 ± 3.72,13.85 ± 7.22,24.00 ± 9.79),time of stay in hospital [days:6.0 (1.0,9.0),12.0 (8.0,22.0),19.5 (7.0,29.0)],the mortality rate (0,10.2％,52.6％),WBC (× 109/L:7.59 ± 3.27,8.94 ± 3.95,10.32 ± 5.50),N (0.685 ± 0.132,0.778 ± 0.135,0.831 ±0.086),hs-CRP [mg/L:4.60 (2.80,7.52),23.58 (13.49,49.22),59.77 (19.36,110.62)] andPCT [μg/L:0.05 (0.05,0.05),0.09 (0.05,0.61),0.63 (0.10,5.25)] showed gradually increasing tendency (all P=0.000).Serum lymphocyte count levels [× 109/L:1.53 (0.89,1.88),0.90 (0.65,1.42) and 0.80 (0.50,1.12)],lymphocyte percentage (0.225 ± 0.122,0.138 ± 0.097,0.106 ± 0.070) showed gradually decreasing tendency (P＜0.05 or P＜0.01).There was significant difference in blood lactic acid among three groups [blood lactic acid were 2.40 (1.30,5.10),1.10 (0.80,2.00) and 1.40 (1.00,2.50) mmol/L in the non-infective SIRS,sepsis and severe sepsis groups respectively,P=0.000].Age (years old:76.71 ± 12.21 vs.73.21 ± 14.49),APACHE Ⅱ score (24.69 ± 9.58 vs.13.91 ± 8.41),time of stay in hospital [days:12.0 (4.0,28.0) vs.11.0 (8.0,22.0)],WBC (× 109/L:10.29 ± 5.82 vs.8.89 ± 3.98),N (0.809 ± 0.130 vs.0.776 ± 0.120),lactic acid [mmol/L:1.80 (1.10,2.90) vs.1.30 (0.90,2.49)],hs-CRP [mg/L:50.94 (19.21,97.13) vs.21.71 (6.39,54.40)] and PCT [μg/L:0.74 (0.13,5.83) vs.0.08 (0.05,0.59)] levels in the death group were higher than those in the survival group (P＜0.05 or P＜0.01),serum lymphocyte count levels [× 109/L:0.90 (0.50,1.29) vs.1.05 (0.70,1.54)],lymphocyte percentage (0.123 ± 0.098 vs.0.143 ± 0.097) level in the death group were obviously lower than those in the survival group (P＜0.01 and P＜0.05).Serum lymphocyte count levels were negative correlated with N (r=-0.597,P=0.000),hs-CRP (r=-0.298,P=0.000),PCT (r=-0.304,P=0.000),APACHE Ⅱ (r=-0.124,P=0.000),and positively correlated with lymphocyte percentage (r=0.691,P=0.000),and non correlations was found with WBC (r=0.082,P=0.091) and lactic acid (r=0.073,P=0.132).Conclusion The serum lymphocyte levels in the critically ill patients are related with the severity of sepsis,and monitoring the change in lymphocyte may be an indicator for evaluating the illness and effect of treatment.
