CAJ | 학술논문

目的探讨外周血淋巴细胞计数在评估脓毒症患者预后中的价值. 方法采用回顾性研究方法,选择2013-01~2014-01 我院诊断的脓毒症患者116例,于入院第1、3、7 天抽取外周血检测淋巴细胞计数( Lym) ,根据28 d、90 d生存情况分为存活组和死亡组,比较两组患者淋巴细胞计数、APACHEⅡ评分、合并症等,并行Logistic回归分析淋巴细胞计数对脓毒症患者预后的预测作用. 结果 ①死亡组的年龄、血肌酐、APACHEⅡ评分高于存活组( P<0.05 ) , ALB水平低于存活组(P<0.05);两组患者的淋巴细胞计数在入院第1天差异无统计学意义(P>0.05),死亡组第3、7天淋巴细胞计数均明显低于存活组(P<0.05). 死亡组合并肾衰竭和心功能不全的比例明显高于存活组( P<0 .05 ). ②ROC曲线显示,淋巴细胞计数对脓毒症患者28 d病死率和90 d病死率均有一定的预测价值,AUC最大值均为第7天(0.772,0.785),两者切点值均近似于1.0 ×109/L. ③第7 天淋巴细胞<1.0 ×109/L组患者的血肌酐、年龄、APACHEⅡ评分、28 d和90 d病死率明显高于淋巴细胞>1.0 ×109/L组. ④多因素Logistic回归分析发现,合并肿瘤、应用机械通气和第7 天的淋巴细胞计数是否<1.0 ×109/L是预测病死率的独立预后因素( P<0.05 ). 结论脓毒症患者第7天的淋巴细胞计数<1 .0 ×10 9/L是预测患者预后不良的预测因素,若结合是否合并肿瘤、是否应用机械通气则能更好地预测脓毒症的预后.
목적 탐토외주혈림파세포계수재평고농독증환자예후중적개치. 방법 채용회고성연구방법,선택2013-01~2014-01 아원진단적농독증환자116례,우입원제1、3、7 천추취외주혈검측림파세포계수( Lym) ,근거28 d、90 d생존정황분위존활조화사망조,비교량조환자림파세포계수、APACHEⅡ평분、합병증등,병행Logistic회귀분석림파세포계수대농독증환자예후적예측작용. 결과 ①사망조적년령、혈기항、APACHEⅡ평분고우존활조( P<0.05 ) , ALB수평저우존활조(P<0.05);량조환자적림파세포계수재입원제1천차이무통계학의의(P>0.05),사망조제3、7천림파세포계수균명현저우존활조(P<0.05). 사망조합병신쇠갈화심공능불전적비례명현고우존활조( P<0 .05 ). ②ROC곡선현시,림파세포계수대농독증환자28 d병사솔화90 d병사솔균유일정적예측개치,AUC최대치균위제7천(0.772,0.785),량자절점치균근사우1.0 ×109/L. ③제7 천림파세포<1.0 ×109/L조환자적혈기항、년령、APACHEⅡ평분、28 d화90 d병사솔명현고우림파세포>1.0 ×109/L조. ④다인소Logistic회귀분석발현,합병종류、응용궤계통기화제7 천적림파세포계수시부<1.0 ×109/L시예측병사솔적독립예후인소( P<0.05 ). 결론 농독증환자제7천적림파세포계수<1 .0 ×10 9/L시예측환자예후불량적예측인소,약결합시부합병종류、시부응용궤계통기칙능경호지예측농독증적예후.
Objective To investigate the peripheral total lymphocyte count ( lym) to predict the value of the prognosis of patients with sepsis .Methods 116 patients with sepsis were collected in our hospital ICU from January 2013 to January 2014 through a prospective study .Blood samples for lym were taken on the 1st, 3rd, 7th day of hospitalization;according to 28-day and 90-day mortality they were divided into the survival group and death group; the lymphocyte count , the APACHEⅡ score, comorbidities between each group were compared .Results ①There was no significant difference between the lym on the 1st day of hospitalization in survival group and non -survival group, but ALB concentrations and lym on the 3rd, 7th day of hospitalization were statistically significant higher in the survival group compared with non -survival group.The age, serum creatinine, APACHEⅡ score and the proportion of patients who associated with renal failure and heart failure in non -survival group were significant higher than the survival group .②The lymphocyte count had a statistically significant for predicting the 28-day and 90 -day mortality, ROC curve showed that the maximum area under the ROC curve ( AUC ) of lym about prognosis for predicting the 28 -day and 90 -day mortality was (0.772, 0.785) on the 7th day, the cut-off point value (cut-off) was 1.0 ×109/L.③According to the lymphocyte count on the 7th day was whether or not higher than 1.0 ×109/L, divided into two groups (lymphocytic <1.0 ×109/L and lymphocyte >1.0 ×10 9/L group), the age, serum creatinine, APACHEⅡ score, 28 -day and 90 -day mortality in lymphocytic <1.0 ×109/L group were significantly higher than that of lymphocyte >1.0 ×109/L group.④In multivariate analyses, lymphopenia (defined as an absolute lymphocyte count <1.0 ×109/L on the 7th day) with tumor and mechanical ventilation were found to be independently factors associated with 28-day survival and 1-year survival ( P <0.05 ) .Conclusion Lymphopenia ( defined as an absolute lymphocyte count <1.0 ×109/L on the seventh day ) is an independent predictor for predicting the prognosis of patients with sepsis, if combined with tumor and mechanical ventilation , it can better predict the survival .