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奥密克戎变异株老年重症感染者细胞免疫指标对预后的价值研究

唐杰夫 杨德兴 刘圣哲 王强 付凯 王振方 栾英 李敏 刘荣

唐杰夫, 杨德兴, 刘圣哲, 王强, 付凯, 王振方, 栾英, 李敏, 刘荣. 奥密克戎变异株老年重症感染者细胞免疫指标对预后的价值研究[J]. 昆明医科大学学报, 2023, 44(12): 87-94. doi: 10.12259/j.issn.2095-610X.S20231214
引用本文: 唐杰夫, 杨德兴, 刘圣哲, 王强, 付凯, 王振方, 栾英, 李敏, 刘荣. 奥密克戎变异株老年重症感染者细胞免疫指标对预后的价值研究[J]. 昆明医科大学学报, 2023, 44(12): 87-94. doi: 10.12259/j.issn.2095-610X.S20231214
Jiefu TANG, Dexing YANG, Shengzhe LIU, Qiang WANG, Kai FU, Zhenfang WANG, Ying LUAN, Min LI, Rong LIU. A Study on Prognostic Value of Cellular Immunological Indicators in Omicron Variant Infected Elderly Severe Patients[J]. Journal of Kunming Medical University, 2023, 44(12): 87-94. doi: 10.12259/j.issn.2095-610X.S20231214
Citation: Jiefu TANG, Dexing YANG, Shengzhe LIU, Qiang WANG, Kai FU, Zhenfang WANG, Ying LUAN, Min LI, Rong LIU. A Study on Prognostic Value of Cellular Immunological Indicators in Omicron Variant Infected Elderly Severe Patients[J]. Journal of Kunming Medical University, 2023, 44(12): 87-94. doi: 10.12259/j.issn.2095-610X.S20231214

奥密克戎变异株老年重症感染者细胞免疫指标对预后的价值研究

doi: 10.12259/j.issn.2095-610X.S20231214
基金项目: 云南省老年疾病临床研究中心-老年共病诊疗及临床转化研究基金资助项目(202102AA310069);昆明医科大学研究生创新基金资助项目(2023S245)
详细信息
    作者简介:

    唐杰夫(1998~),男,湖南衡阳人,医学硕士,住院医师,主要从事危急重症研究工作

    通讯作者:

    刘荣,E-mail:2665834124@qq.com

  • 中图分类号: R563

A Study on Prognostic Value of Cellular Immunological Indicators in Omicron Variant Infected Elderly Severe Patients

  • 摘要:   目的  探讨奥密克戎变异株老年重症感染者的临床细胞免疫学指标特征及其与预后的关系。  方法  回顾性分析2022年12月至2023年2月昆明医科大学第一附属医院老年ICU收治的53例奥密克戎变异株感染者的临床资料,将其分为存活组(n = 22)、死亡组(n = 31),进行组间比较。采用Logistic分析确定奥密克戎变异株老年重症感染者的预后因素并构建ROC曲线。  结果  多因素Logistic分析显示IL-6升高(P = 0.043)和T淋巴细胞绝对值下降(P = 0.011)是预后的独立危险因素。使用IL-6、T淋巴细胞绝对值和二者联合进行Logistic回归分析所得到的值分别构建ROC曲线,得到的曲线下面积分别为0.818、0.796和0.887。  结论  IL-6升高及T淋巴细胞绝对值下降是奥密克戎变异株老年重症感染者预后的独立危险因素。
  • 图  1  IL-6、T淋巴细胞绝对值预测奥密克戎变异株老年重症感染者28 d预后ROC曲线

    Figure  1.  The ROC curves of IL-6 and absolute T lymphocyte count in prediction of 28 d prognosis of Omicron variant infected elderly severe patients

    表  1  2组患者基线资料比较[M(P25,P75)/n(%)/$\bar x \pm s$]

    Table  1.   Comparison of baseline data between the two groups [M(P25,P75)/n(%)/$\bar x \pm s$]

    变量死亡组
    n = 31)
    存活组
    n = 22)
    t/z/χ2P
    年龄(岁) 77.00(64.00,89.00) 78.50(69.25,84.50) −0.09 0.814
    性别 26(83.87) 15(68.18) 1.808 0.179
    5(16.13) 7(31.82)
    高血压 19(61.29) 10(45.45) 1.302 0.254
    糖尿病 13(41.93) 9(40.91) 0.006 0.940
    慢性肾病 2(6.45) 0(0.00) 0.505
    冠心病 3(9.68) 3(13.64) 0.683
    脑血管
    意外
    6(19.35) 1(4.54) 0.218
    慢阻肺 3(9.68) 0(0.00) 0.258
    病情分级 重型 2(6.45) 8(36.36) 5.694 0.017*
    危重型 29(93.55) 14(63.64)
    APACHEII评分 17.27±6.35 13.91±6.04 1.948 0.057
    SOFA
    评分
    8.58±2.55 6.54±2.97 2.671 0.010*
    GCS评分   8.00(6.00,12.00) 13.50(8.50,15.00) −2.490 0.013*
      APACHE-II评分:急性生理与慢性健康评分;SOFA评分:序贯器官衰竭评估评分;GCS评分:格拉斯哥昏迷评分;存活组与死亡组组间比较,*P < 0.05。
    下载: 导出CSV

    表  2  2组患者一般实验室检查比较[ M(P25,P75)/$\bar x \pm s $]

    Table  2.   Comparison of laboratory test results between the two groups [ M(P25,P75)/$\bar x \pm s $]

    变量死亡组 (n = 31)存活组 (n = 22)z/tP
    核酸检测CT值 29.00(25.99,34.00) 32.00(28.00,36.54) −1.293 0.196
    血乳酸(mmol/L) 2.10(1.40,3.10) 1.50(1.15,1.95) −2.006 0.045*
    pH值 7.41(7.34,7.46) 7.45(7.41,7.49) −2.541 0.011*
    OI(mmHg) 102.00(66.00,174.00) 201.00(167.75,278.00) −3.448 0.001*
    白细胞计数(x109/L) 12.10±6.53 11.00±6.65 0.598 0.553
    中性粒细胞百分比(%) 91.50(86.40,94.60) 86.85(76.30,92.92) −1.995 0.046*
    中性粒细胞绝对值(x109/L) 10.95±5.89 9.66±6.51 0.751 0.456
    淋巴细胞绝对值(x109/L) 0.37(0.26,0.78) 0.79(0.50,1.03) −2.528 0.011*
    血小板计数(x109/L) 180.58±69.64 200.50±106.56 −0.824 0.414
    中性粒细胞淋巴细胞比值 23.14(11.65,39.97) 12.48(4.86,24.53) −2.445 0.014*
    血小板淋巴细胞比值 425.00(246.88,682.61) 272.42(175.36,408.03) −1.769 0.077
    PCT(ng/mL) 0.45(0.19,2.02) 0.24(0.09,0.41) −2.048 0.041*
    HS-CRP(mg/L) 79.60(38.80,122.10) 45.80(23.70,139.97) −0.774 0.439
    血清铁蛋白(ng/L) 1410.50(859.50,2662.20) 1340.00(626.27,2285.00) −0.614 0.553
    PT(s) 14.60(13.40,17.10) 13.90(13.27,14.90) −1.201 0.230
    APTT(s) 37.60(34.50,40.60) 39.35(36.17,44.72) −1.110 0.267
    D二聚体(mg/L) 2.27(1.41,7.31) 1.64(0.99,4.36) −1.379 0.168
    ALT(U/L) 22.50(12.45,40.67) 28.70(18.70,91.33) −1.345 0.179
    AST(U/L) 38.60(26.21,67.20) 36.44(20.57,73.35) −0.469 0.639
    尿素(mmol/L) 10.64(7.05,21.07) 8.00(5.17,15.20) −1.462 0.144
    肌酐(μmol/L) 108.10(74.80,267.20) 88.80(72.21,88.80) −1.468 0.134
    ALB(g/L) 32.00(28.90,33.90) 35.00(31.57,37.67) −1.977 0.048*
    血糖(mmol/L) 9.52(7.01,13.80) 8.05(5.79,11.90) −1.278 0.201
    cTnI(ng/mL) 0.13(0.04,0.38) 0.04(0.02,0.18) −1.462 0.144
    BNP(pg/mL) 176.38(116.29,409.44) 78.60(37.54,209.50) −1.986 0.047*
      OI:氧合指数;PCT:降钙素原;HS-CRP:超敏C反应蛋白;PT:凝血酶原时间;APTT:活化部分凝血活酶时间;ALT:谷丙转氨酶;AST:谷草转氨酶;ALB:白蛋白;cTnI:肌钙蛋白I;BNP:脑钠肽;存活组与死亡组组间比较,*P < 0.05。
    下载: 导出CSV

    表  3  2组患者12项细胞因子检测比较[M(P25,P75)]

    Table  3.   Comparison of 12 cytokines between the two groups[M(P25,P75)]

    变量死亡组(n = 31)存活组(n = 22)zP
    IL-1β(pg/mL) 1.99(1.41,3.23) 1.24(1.41,3.23) −1.772 0.076
    IL-2(pg/mL) 1.46(1.23,1.75) 1.01(0.76,1.61) −2.779 0.005*
    IL-4(pg/mL) 1.03(0.85,1.27) 0.86(0.30,1.11) −1.791 0.073
    IL-5(pg/mL) 1.53(1.32,2.67) 1.60(1.23,2.05) −0.299 0.765
    IL-8(pg/mL) 5.30(1.76,37.53) 6.89(1.04,19.33) −0.718 0.473
    IL-10(pg/mL) 3.27(1.95,8.30) 1.70(1.45,2.70) −2.798 0.005*
    IL-6(pg/mL) 64.43(16.84,206.14) 11.78(4.16,28.38) −3.730 < 0.001*
    IL-12P70(pg/mL) 0.97(0.68,1.25) 0.58(0.38,0.99) −2.462 0.014*
    IL-17(pg/mL) 3.95(0.38,11.85) 1.20(0.65,2.93) −0.774 0.439
    IFN-α(pg/mL) 1.06(0.64,1.91) 0.60(0.39,1.62) −1.809 0.070
    IFN-γ(pg/mL) 1.15(0.56,1.86) 1.26(0.78,2.86) −1.203 0.229
    TNF-α(pg/mL) 1.04(0.75,1.50) 0.84(0.54,1.33) −1.240 0.215
      IL:白细胞介素;IFN:可溶性二聚体细胞因;TNF:肿瘤坏死因子;存活组与死亡组组间比较,*P < 0.05。
    下载: 导出CSV

    表  4  2组患者T淋巴细胞亚群检测比较[M(P25,P75)/$ \bar x \pm s $]

    Table  4.   Comparison of T lymphocyte subsets examination data between the two groups[M(P25,P75)/$ \bar x \pm s $]

    变量死亡组(n = 31)存活组(n = 22)t/zP
    淋巴细胞绝对值(个/μL) 399.00(295.00,726) 714.00(337.00,1024.50) −3.594 < 0.001*
    T淋巴细胞绝对值(个/μL) 302.00(217.00,455.50) 395.00(216.00,552.00) −3.515 < 0.001*
    细胞毒/抑制性T细胞绝对值(个/μL) 102.50(60.00,455.00) 120.00(93.00,230.00) −2.634 0.008*
    Th辅助性T细胞绝对值(个/μL) 164.00(112.00,236.00) 202.00(107.00,312.00) −2.971 0.003*
    NK细胞绝对值(个/μL) 67.50(34.25,154.50) 154.00(52.50,219.50) −1.709 0.087
    B淋巴细胞绝对值(个/μL) 74.50(24.00,148.75) 51.00(28.00,187.50) −1.567 0.117
    CD4/CD8比值 1.86±0.89 1.80±1.28 −0.184 0.855
      存活组与死亡组组间比较,*P < 0.05。
    下载: 导出CSV

    表  5  2组患者感染相关免疫细胞比较[$\bar x \pm s$]

    Table  5.   Comparison of infection-related immune cells data between the two groups[$ \bar x \pm s$ ]

    变量死亡组(n = 31)存活组(n = 22)tP
    CD64感染指数 4.80±0.90 2.40±1.47 −4.1 < 0.001*
    HLA-DR(%) 36.78±21.09 66.56±24.60 2.8 0.01*
    Treg(%) 9.34±1.65 11.33±3.54 1.47 0.16
      HLA-DR:人类白细胞抗原DR; Treg:调节性T淋巴细胞;存活组与死亡组组间比较,*P < 0.05。
    下载: 导出CSV

    表  6  2组患者治疗措施比较[n(%),M(P25,P75)]

    Table  6.   Comparison of treatment measures data between the two groups[n(%),M(P25,P75)]

    变量死亡组(n=31)存活组(n=22)z/χ2P
    使用血管活性药物 30(96.77) 9(40.90) 20.661 <0.001*
    使用激素 26(83.87) 17(77.27) 0.062 0.724
    使用免疫调节剂 20(64.52) 16(72.73) 0.402 0.526
    使用抗凝药物 27(87.09) 18(81.81) 0.705
    使用机械通气 29(93.55) 17(77.27) 0.113
    使用俯卧位通气 6(19.35) 10(45.45) 4.159 0.042*
    PEEP(cmH2O) 8.00(6.00,10.00) 7.00(6.00,7.00) −0.740 0.486
      PEEP:呼气末正压;存活组与死亡组组间比较,*P < 0.05。
    下载: 导出CSV

    表  7  免疫指标多因素Logistic回归分析

    Table  7.   The multivariate Logistic regression analysis of immune indicators

    变量OR(95%CIP
    IL-6(pg/mL)1.023(1.101~1.047)0.043*
    T淋巴细胞绝对值(个/μL)0.994(0.989~0.999)0.011*
      IL:白细胞介素;存活组与死亡组组间比较,*P < 0.05。
    下载: 导出CSV

    表  8  IL-6、T淋巴细胞绝对值预测奥密克戎变异株老年重症感染者28 d预后ROC曲线

    Table  8.   The ROC curves of IL-6 and absolute T lymphocyte count in prediction of 28 d prognosis of Omicron variant infected elderly severe patients

    变量曲线下面积95%CI
    IL-60.8180.702~0.933
    T淋巴细胞绝对值0.7960.656~0.936
    联合预测0.8870.793~0.980
      IL:白细胞介素。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-09-13
  • 网络出版日期:  2023-12-22
  • 刊出日期:  2023-12-25

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