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

Objective To observe the changes of T lymphocyte subsets in patients with sepsis, and discuss its relationship with condition and prognosis.Methods All the observe subjects were selected from the admission patients of the EICU of Tianjin medical university general hospital.60 patients with sepsis aged 25-85yr and 40 patients with severe sepsis aged 32-88yr were included while 30 non-septic patients aged 44-84yr were included as control group. The patients with sepsis and severe sepsis met sepsis criteria according to 2001 SCCM/ESICM/ACCP/AIS/SIS International Sepsis Definition Conference. Patients who had autoimmune diseases, immunologic deficiency disease, tumor, received immunosuppressant recently were excluded. Flow cytometer was used to detect the percentage of CD3+T, CD4+T and CD8+T, and count CD4+T/CD8+T in the first day and seventh day after admission. At the same time we collected clinical variables of all patients after they were hospitalized within 24 hours, and calculated APACHEⅡscore. According to the outcome, patients with sepsis were divided into survival group and non-survival group, then the detection data were compared. 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 also used receiver operating characteristic curve analysis in the percentage of CD4+T and APACHEⅡscore for prognosis in the patients with sepsis.Results In the first day of admission, compared with the patients with sepsis and non-septic patients, the patients with severe sepsis had a lower CD3+T, CD4+T and CD4+T/CD8+T (P<0.05), and a higher APACHEⅡscore (P<0.05). There was no statistical difference between non-septic and septic patients on CD3+T, CD4+T, CD8+T, CD4+T/CD8+T and APACHEⅡscore (P>0.05). In the seventh day of admission, non-survival patients with sepsis had a statistical decrease of CD3+T, CD4+T and CD4+T/CD8+T (P<0.05), and a statistical increase of APACHEⅡscore (P<0.05); non-survival patients with severe sepsis had no statistical change of CD3+T, CD4+T and CD4+T/CD8+T (P>0.05), and a statistical increase of APACHEⅡscore (P<0.05). The values measured showed a negative linear correlation between CD4+T and APACHEⅡscore (r=-0.56, P<0.05). According to the multivariate logistic regression analysis, CD4+T, APACHEⅡscores and the number of dysfunction organ were independent risk factors for judging the prognosis in the patients with sepsis. There are under ROC curve for the percentage of CD4+T was 0.792±0.078, for the APACHEⅡscore was 0.942±0.029.Conclusion T lymphocyte subsets in septic patients are different at different stages of the disease, compared with septic patients, patients with severe sepsis exist cellular immune impairment severer. With the progress of sepsis, septic patients with worse cellular immune impairment, severe septic patients with cellular immune impairment unrecovered indicate a bad outcome. The percentage of CD4+T lymphocyte in peripheral blood can reflect the severity of sepsis, dynamic detection of T lymphocyte subsets in the peripheral blood of septic patients is helpful in judging the severity of disease and predicting the prognosis.