The Change And Clinical Significance Of T-lymphocyte Subsets In Patients With Multiple Organ Dysfunction Syndrome

Objective:To observe the change of T-lymphocyte subsets in patients with multiple organ dysfunction syndrome(MODS),and evaluate the clinical significance of it in patients with MODS。Methods:40 MODS patients were included in this study who were admitted to the Emergency Center of TianJin Medical University General Hospital from August 2007 to July 2008.On the other hand,40 non-MODS patients who were admitted at the same time were included as control group,Patients who had autoimmune diseases, immunodeficiency diseases,hypersensitivity reaction diseases,tumor,diabetes and received immunosuppressant or cyclooxygenase inhibitor(ex Aspirin,etc) recently were excluded.We collected the data of the patients's age,sex,body temperature,pulse,respiration,blood pressure,blood routine,urine routine,liver and kidney function,electrolytes,glucose,enzymes,C-reactive protein(CRP), Erythrocyte Sedimentation Rate(ESR) and arterial blood gas analysis within 24 hours from admitting to the hospital,and calculated the acute physiology and chronic health evaluationⅡscore(APACHEⅡscore).At the same time,the percentage of CD3~+T, CD4~+T,CD8~+T lymphocyte of peripheral blood and the ratio of CD4~+T/CD8~+T were detected to evaluate the function of cell immune system.All data were entered into the computer and satistical analysis was performed with SPSS 16.0.We compared the differences of the indexes between the groups.In MODS group,based on a single factor logistic regression analysis according to prognosis to define the risk factors,we performed the multinomial logistic regression analysis and found the independent risk factors which had important effect on clinical.They were showed and compared by receiver-operating-characteristic curve(ROC) analysis with MedCalc10.3.Results:There are no significant differences at age,sex,lymphocyte count, lymphocyte percentage,CRP,ESR,ALT,AST,ALP,TBIL and DBIL between MODS group and non-MODS group.Compared to non-MODS patients,patients with MODS had a significant decrease of percentage of CD3~+T lymphocyte(MODS group 58.27±9.84,non-MODS group 64.16±6.86) and CD4~+T lymphocyte(MODS group 51.67±11.81,non-MODS group 60.73±6.23) as well as CD4~+T/CD8~+T ratio(MODS group 1.17±0.43,non-MODS group 1.86±0.49),ALB(MODS group 32.59±4.76, non-MODS group 35.38±5.95) and Ca2~+(MODS group 2.06±0.15,non-MODS group 2.15±0.15),and also had a significant crease of percentage of CD8~+T lymphocyte(MODS group 47.14±9.32,non-MODS group 34.29±6.64),APACHEⅡscore(MODS group 25.25±3.42,non-MODS group 22.25±2.19)(p＜0.05).There are no significant difference at age,sex,lymphocyte count,lymphocyte percentage,percentage of CD3~+T lymphocyte of peripheral blood,ALB,CRP,ESR, ALT,AST,ALP,Ca2~+,CK-MB,TBIL and DBIL between survival group and non-survival group of MODS patients(p＞0.05).Compared to survival patients, patients who non-survived had a significant decrease of percentage of CD4~+T lymphocyte(non-survival group 44.60±12.12,survival group 56.39±9.09) and CD4~+T/CD8~+T ratio(non-survival group 0.90±0.27,survival group 1.33±0.40),and also had a significant crease of percentage of CD8~+T lymphocyte(non-survival group 52.11±10.18,survival group 43.83±7.14) and APACHEⅡscore(non-survival group 27.50±2.99,survival group 23.75±2.85)(p＜0.05).It showed that CD4~+T/CD8~+T ratio and APACHEⅡscore are two independent risk factors for prognosis of the patients with MODS,after performed the multinomial logistic regression analysis.The area under ROC curve of the CD4~+T/CD8~+T ratio was 0.902±0.048,and it of APACHEⅡscore was 0.819±0.073.There was no significant difference between them(p＞0.05).Conclusions:1.Patients with MODS had a significant decrease of percentage of CD3~+T lymphocyte and CD4~+T lymphocyte as well as CD4~+T/CD8~+T ratio and also had a significant crease of percentage of CD8~+T lymphocyte.It shows that there are cellar immunfunctional impairement in patients with MODS.2.CD4~+T/CD8~+T ratio can be used to evolute the severtity of patients with MODS. A lower CD4~+T/CD8~+T ratio indicates a more Serious condition and a more poor prognosis.