Changes And Clinical Significance Of Lymphocyte Subsets In Patients With Sepsis

Objective: Sepsis is a common disease in the ICU ward,It is one of the major threats that caused the death of critically ill patients.Studies have found that there is immunosuppression in the process of sepsis,and it plays an important role in the pathogenesis of sepsis.This article evaluates the changes of blood lymphocyte subsets in patients with sepsis and its significance in the diagnosis and prognosis of sepsis by case-control study.Method: Seventy-seven patients with sepsis admitted to the ICU of Tongji Hospital affiliated to Huazhong University of Science and Technology from July 2018 to December2018 were selected as the sepsis group.31 patients with non-sepsis who were admitted to the ICU ward at the same time were used as the control group.The basic clinical indicators(APACHE II score,SOFA score,various organ function indicators)of the two groups of patients were collected.Within 24 hours after the patients entering the ICU ward,the blood lymphocyte subsets,inflammatory factors,lactic acid of the patients were measured.These indicators were statistically analyzed to find ifferences between the two groups so as to assess the significance of blood lymphocyte subsets in the diagnosis and evaluation of sepsis.Then,the sepsis group was divided into two subgroups according to clinical prognosis: death group and survival group.The significance of blood lymphocyte subsets on the prognosis of sepsis was analyzed statistically.Result: Compared with non-sepsis patients,blood CD4+Th lymphocytes(222±237/?l VS 487±300/?l,P<0.05),B lymphocytes(122±115/?l VS 381±219/?l,P<0.05),NK lymphocytes(95±171/?l VS 222±120/?l,P<0.05),and T+B+NK total lymphocytes(731±1228/?l VS1438±737/?l,P<0.05)were significantly lower in the sepsis group;while blood CD4+/CD8+ ratio(2.49±2.09 VS 1.39±0.41,P<0.05),PCT(4.47±36.05ng/ml VS0.90±1.01ng/ml,P<0.05),The level of IL-6(2059.9±2145.8pg/ml VS748.8±1138.8pg/ml,P<0.05)was significantly elevated in the sepsis patients.However,therewas no significant difference in blood lymphocyte subsets between the death group and the survival group.The diagnostic results of blood lymphocyte subsets and other indicators were evaluated by plotting ROC curves.The results showed that SOFA scores(ROCAUC0.941),PCT(ROCAUC 0.914),lactic acid(ROCAUC 0.856),and APACHE II score(ROCAUC 0.813)were are significant for the diagnosis of sepsis.,while blood lymphocyte subsets have limited diagnostic value for sepsis.Among the different subgroups,APACHE II score(24±9 VS 17±9,P<0.05),SOFA score(11±3 VS 8±3,P<0.05),IL-6(2706±2284pg/ml VS 1549±1904pg/ml,P<0.05)and blood lactate levels(5.88±4.23mmol/l VS 2.63±1.77mmol/l,P<0.05)of the death group were higher than the survival group.Logistic regression analysis showed that SOFA score and lactate level were negatively correlated with prognosis.Conclusion: There is immunosuppression in patients with sepsis,which performed as reduced lymphocytes.The elevated level of PCT is helpful to assess the severity of the disease.SOFA score,APACHE II score and lactate level are of great value in judging prognosis.