Clinical Significance Of The Change Of T Lymphocyte Subsets In The Patients With Sepsis

Objective:To observe the change of T lymphocyte subsets in the patients with sepsis,and discuss the clinical significance on the patients with sepsis.Methods:The 104 patients who were divided into sepsis group and non-sepsis group were studied after they were admitted to emergency centre of Tianjin Medical University General hospital from August 2007 to July 2008.The 74 patients with sepsis who met sepsis criteria according to 2001 SCCM/ESICM/ACCP/AIS/SIS International Sepsis Definition Conference were selected as sepsis group,other 30 patients were selected as non-sepsis group. Patients who had autoimmune diseases,immunologic deficiency disease,hypersensitivity reaction diseases,tumor,diabetes mellin,trauma,operation related diseases and received immunosuppressant or cyclooxygenase inhibitor(for example Aspirin )recently were excluded.We collected clinical variables of all patients after they were hospitalized within 24 hours,and calculated APACHEⅡscore.At the same time,in order to explore the function of cell immune system of patients,the percentage of CD3~+T,CD4~+T,CD8~+T lymphocyte of peripheral blood and the ratio of CD4~+T /CD8~+T were detected in the first day. Based on a single factor logistic regression analysis to define the risk factors,we performed the multinomial logistic regression analysis and found independent risk factors which had important effect on clinical.We divided the 74 patients with sepsis into non-survival and survival group according to the prognosis in hospital, and compared the clinical variable difference between the two groups.We also used receiver-operating-characteristic curve(ROC) analysis in the percentage of CD4~+T lymphocyte of peripheral blood and APACHEⅡscore for prognosis in the patients with sepsis.Results:There are significant the difference between sepsis group and non-sepsis groups with the percentage of CD3~+T lymphocyte in peripheral blood(sepsis group 57.99±8.92,non-sepsis group 64.52±10.31,P＜0.01),and the percentage of CD4~+T lymphocyte in peripheral blood(sepsis group 47.09±11.92,non-sepsis group 64.47±10.70,P＜0.01),and the ratio of CD4~+T/CD8~+T lymphocyte(sepsis group 1.34±0.63,non-sepsis group 2.13±1.16,p＜0.01).There are significant difference in peripheral blood the percentage of CD4~+T lymphocyte(non-survival group 34.84±6.62,survival group 53.35±8.73,P＜0.01),the percentage of CD8~+T lymphocyte(non-survival group 36.30±8.69,survival group 43.08±9.49,p＜0.01),and the ratio of CD4~+T/CD8~+T lymphocyte(non-survival group 0.84±0.38,survival group 1.59±0.57,p＜0.01) between non-survival group and survival group of patients with sepsis.After performing the multinomial logistic regression analysis,we found that the percentage of CD4~+T lymphocyte in peripheral blood and APACHEⅡscore are two independent risk factors for prognosis in the patients with sepsis.There are under ROC curve for the percentage of CD4~+T lymphocyte was 0.954±0.023,for the APACHEⅡscore was 0.910±0.0415.Conclusions:1.The percentage of CD3~+T lymphocyte,CD4~+T lymphocyte in peripheral blood and the ratio of CD4~+T/CD8~+T lymphocyte in the patients with sepsis are lower than non-sepsis,these indicate that septic patients exist immunofunctional impairment.2.The percentage of CD4~+T lymphocyte in peripheral blood can reflect the severity of sepsis and predict the prognosis of the patients with sepsis effectively.The lower level of the percentage of CD4~+T lymphocyte in peripheral blood,the more severe sepsis and poor prognosis.