Clinical Research Of Immunological Function In Emergency And Critical Patients:reports Of 72 Cases

Objective: To further explore the immune function of emergency and critical patients and provide theoretical basis for clinical diagnosis and treatments by observing the change of peripheral blood T lymphocyte subsets, and total protein(TP), albumin(ALB), globulin(GLOB) and c-reactive protein(CRP) levels.Methods: 116 emergency and critical patients were collected,which were came from the first affiliated hospital of Wannan Medical College,during October 2013- November 2014, 44 healthy people served as the control group. Conform to the criteria for the screening of patients,72 cases were enrolled as critical group, The blood samples were collected on the first 24 hours,flow cytometry was used to detect the ratios of peripheral CD3+T cells,CD4+T cells,CD3+CD8+T cells,CD3-CD16+56+T cells,CD3-CD19+ cells and CD4+/CD8+ratio.At the same time,all the patient were asked to draw venous blood on an empty stomach biochemical detection day 2 after admission.SPSS17.0 statistical software was used for statistical analysis.Results: Compared with healthy people,the critical group were lower in percentage of peripheral blood CD3+ T, CD3+CD4+T,CD3-CD19+ cells and CD4+/CD8+ ratio [(56.63±6.19)% vs(69.84±4.82)%,(29.23±4.25)% vs(35.55±4.88)%,(12.40±3.35)% vs(15.13±2.79)%,(1.30±0.33) vs(1.50±0.34)], the percentage of CD8+T cell was higher than healthy people[(26.91±5.70)% vs(24.50±4.22)%], the difference was statistically significant(P<0.05),the difference of percentage of CD3-CD16+56+ cellbetween two groups had no statistically significance(P>0.05).The serum concentration of CRP in critical group was higher than that of healthy people [(80.52±17.76) mg/L) vs(0.47 ± 0.08) mg/L], the difference was obviously statistically significant(P<0.01),The serum concentration of TP,ALB and GLOB were lower than healthy people[(53.74±5.48) g/L vs(75.02±4.14) g/L,(28.09±3.95) g/L vs(46.87±3.13) g/L,(25.74±3.65) g/L vs(27.97±2.91) g/L), the difference was statistically significant(P<0.05).The selected 72 cases of emergency and critical patients(the critical group) were divided into survival group(36 cases) and death group(36 cases) according to the result of 28 days of follow-up.Campared with survival group,the percentage of peripheral blood CD3+T, CD3+CD4+T, CD3-CD19+ cell were lower in death group[(53.41±4.84)% vs(59.85±5.73)%,(27.93±3.76)% vs(30.52±4.38)%,(11.14±3.31)% vs(13.67±2.93)%],the difference was statistically significant(P<0.05), the differences of percentage of peripheral blood CD8+ T,CD3-CD16+56+ cells and CD4+/CD8+ ratio had no statistically difference(P>0.05),the serum concentrations of CRP was higher in death group [(93.69±9.98) mg/L) vs(66.22±9.58) mg/L], the serum concentrations of TP and ALB were lower in survival group[(51.86±4.85) g/L vs(55.63±5.47) g/L,(26.83±3.17) g/L vs(29.91±3.07) g/L], the difference was statistically significant(P<0.05), there was no statistically significant difference in the serum concentration of GLOB(P>0.05).Pearson correlation analysis: the percentage of CD3+T lymphocytes were negatively correlated to the level of CRP(r = 0.544, P = 0.000). ROC curve showed the percentage of CD3+、 CD3+CD4+、 CD3-CD19+ lymphocytes, and the serum concentration of CRP、TP and ALB were significant for predicting the prognosis of emergency and critical patients(AUC = 0.807, AUC = 0.619, AUC = 0.717, AUC = 0.970, AUC = 0.693, AUC = 0.738).Conclusion : 1.T.he percentage of peripheral blood CD3,CD3CD4 and CD3CD19Tlymphocyte in emergency and critical patients were lower and CD8+ lymphocyte were higher than the healthy controls. 2.Compared with healthy controls, those patients had a lower concentration in serum TP and ALB, a higher concentration of CRP. 3.The percentage of CD3 + T lymphocyte was negatively correlated with CRP level. 4.The percentage of CD3+、 CD3+CD4+、 CD3-CD19+ lymphocytes, and the serum concentration of CRP、TP and ALB were significant for predicting the prognosis of emergency and critical patients.The ROC curve analysis to get the best boundary of CRP value point was 85.15 mg/ml, and the percentage of CD3 + lymphocytes was 56.4%...