CD3+和CD4+T水平可预测老年脓毒症患者病情危重及不良预后

张强.CD3+和CD4+T水平可预测老年脓毒症患者病情危重及不良预后[J].内科急危重症杂志,2025,31(3):252-254

DOI：10.11768/nkjwzzzz20250312

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作者	单位	E-mail
张强	海安市人民医院重症医学科	18962782891@189.cn

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中文摘要:

摘要目的：探讨外周血CD3+、CD4+、CD8+T细胞数目及细胞因子水平与老年脓毒症患者免疫功能和预后的关系。方法：收集住院治疗的60例老年脓毒症患者临床资料，根据病情严重程度分为脓毒症组（34例）、严重脓毒症组（15例）和脓毒症休克组（11例），并根据28d后临床结局分为存活组（39例）和死亡组（21例）。另选取同期健康体检者30例为对照组。通过流式细胞仪器检测各组外周血中CD3+、CD4+及CD8+T的细胞数目，通过酶联免疫吸附法测定各组血清白介素（IL）-1、IL-6、IL-10及肿瘤坏死因子-α（TNF-α）水平。结果：与对照组比较，3组老年脓毒症患者外周血CD3+、CD4+及CD8+T细胞的绝对数目降低，且病情越重降低幅度越大；血清中IL-1、IL-6、IL-10及TNF-α水平显著升高，其中IL-1及IL-10水平随病情加剧变化幅度越大（P均<0.05）。与存活组比较，死亡组患者外周血CD3+、CD4+T细胞显著降低，而血清IL-1及TNF-α水平显著增加（P均＜0.05）。受试者工作特征（ROC）曲线提示IL-1判断预后所对应的曲线下面积最大，CD3+T细胞绝对数目的敏感度高达100%。结论：老年脓毒症患者外周血CD3+、CD4+T细胞数目及IL-1及TNF-α水平可作为判断患者免疫功能和预后的指标。

英文摘要:

Abstract Objective: To investigate the relationship between peripheral blood CD3+, CD4+, CD8+ T cell counts, cytokine levels, immune function, and prognosis in elderly sepsis patients. Methods: The clinical data from 60 hospitalized elderly sepsis patients were collected. Based on disease severity, patients were divided into sepsis (34 cases), severe sepsis (15 cases), and septic shock (11 cases) groups, and further classified into survival (39 cases) and death (21 cases) groups according to 28-day outcomes. A total of 30 healthy individuals were included as controls. Flow cytometry was used to measure peripheral blood CD3+, CD4+, and CD8+ T cell counts, and enzyme-linked immunosorbent assay (ELISA) was employed to determine serum levels of interleukin (IL)-1, IL-6, IL-10, and tumor necrosis factor-α (TNF-α). Results: Compared with the control group, all sepsis groups showed reduced absolute counts of CD3+, CD4+, and CD8+ T cells, with more pronounced reductions in severe cases. Serum IL-1, IL-6, IL-10, and TNF-α levels were significantly elevated, particularly IL-1 and IL-10, which increased progressively with disease severity (all P< 0.05). Compared with survivors, non-survivors exhibited significantly lower CD3+ and CD4+ T cell counts and higher IL-1 and TNF-α levels (all P< 0.05). Receiver operating characteristic (ROC) curve analysis revealed that IL-1 had the largest area under the curve (AUC) for prognosis prediction, while CD3+ T cell counts demonstrated 100% sensitivity. Conclusion: Peripheral blood CD3+ and CD4+ T cell counts, along with IL-1 and TNF-α levels, may serve as indicators of immune status and prognosis in elderly sepsis patients.