摘要
目的探讨脓毒症患儿外周血淋巴细胞亚群的变化特点及联合多项指标辅助诊断儿童脓毒症的价值。方法采用回顾性分析,选取2022年10月—2024年10月河北省儿童医院收治的脓毒症患儿86例和同期局部感染患儿83例作为研究对象,比较两组患儿的临床基线资料、外周血淋巴细胞亚群等实验室检测指标。采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator regression,LASSO)回归及二元多因素Logistic回归分析脓毒症发生的独立危险因素。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价各危险因素对脓毒症患儿的辅助诊断价值。结果脓毒症组凝血酶时间、NK细胞绝对计数、CD3^(+)T细胞绝对计数、CD4^(+)T细胞绝对计数、CD8^(+)T细胞绝对计数、IgG和IgM含量、淋巴细胞计数、血小板计数均低于局部感染组,凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间,以及纤维蛋白原、直接胆红素、C反应蛋白(C-reactive protein,CRP)水平均高于局部感染组(P均<0.05)。将LASSO回归分析筛选出的变量纳入二元多因素Logistic回归分析中显示,PT、CD4^(+)T、IgM、CRP为脓毒症发生的独立危险因素。基于上述危险因素绘制ROC曲线,PT、CD4^(+)T、IgM、CRP单独诊断脓毒症的ROC曲线下面积分别为0.729、0.593、0.605、0.795;4项指标联合检测的曲线下面积为0.822,优于单一指标检测。结论联合检测PT、CD4^(+)T、IgM、CRP可提高对脓毒症患儿的诊断效能,及早监测上述指标可以评估脓毒症患儿的病情。
ObjectiveTo investigate the features of peripheral blood lymphocyte subsets in children with sepsis and evaluate the value of these cells in combination with multiple indicators in the diagnosis of pediatric sepsis.MethodsA retrospective study was conducted on 86 sepsis children and 83 children with local infection admitted to Hebei Children′s Hospital from October 2022 to October 2024.Baseline clinical data,peripheral blood lymphocyte subsets,and other laboratory indicators were compared between the two groups.The least absolute shrinkage and selection operator(LASSO)regression and multivariate logistic regression were used to evaluate the independent risk factors correlated with the initiation of sepsis.The receiver operating characteristic(ROC)curve was plotted to evaluate the value of each independent risk factor for diagnosing sepsis.ResultsThe thrombin time,the absolute counts of NK,CD3^(+)T,CD4^(+)T,and CD8^(+)T cells,the levels of IgG and IgM,and the counts of lymphocytes and platelets were lower in the sepsis children than in the children with local infection.However,the prothrombin time(PT),activated partial thromboplastin time,the levels of fibrinogen,direct bilirubin,and C-reactive protein(CRP)were higher in the sepsis group(all P<0.05).The variables screened by LASSO regression were analyzed by the multivariate logistic regression,and the results showed that PT,absolute CD4^(+)T cell count,and the levels of IgM and CRP were independent risk factors for sepsis.The ROC analysis indicated that the area under the ROC curve(AUC)for PT,absolute CD4^(+)T cell count,and IgM and CRP levels when used individually in diagnosing sepsis was 0.729,0.593,0.605,and 0.795,respectively.The AUC for the four indexes when used in combination for diagnosing sepsis reached 0.822,showing greater superiority over that of the single index.ConclusionsThe combined measurement of PT,absolute CD4^(+)T cell count,and the levels of IgM and CRP can improve the diagnostic efficacy for sepsis in children.Early monitoring of these indexes facilitates the assessment of the condition in children suffering from sepsis.
作者
苏靖
徐梅先
白英
曹贝贝
王乐
马莹莹
郭映辉
Su Jing;Xu Meixian;Bai Ying;Cao Beibei;Wang Le;Ma Yingying;Guo Yinghui(Department of Laboratory Medicine,Hebei Children′s Hospital,Shijiazhuang 050031,China;Pediatric Intensive Care UnitⅠ,Hebei Children′s Hospital,Shijiazhuang 050031,China;Institute of Pediatrics,Hebei Children′s Hospital,Shijiazhuang 050031,China;Department of Critical Care Medicine,Hebei Children′s Hospital,Shijiazhuang 050031,China)
出处
《中华微生物学和免疫学杂志》
北大核心
2025年第7期541-547,共7页
Chinese Journal of Microbiology and Immunology
基金
河北省医学科学研究课题计划(20250124)。
关键词
脓毒症
免疫抑制
淋巴细胞亚群
儿童
Sepsis
Immunosuppression
Lymphocyte subsets
Children
