摘要
目的探讨自然杀伤T细胞(NKT细胞)联合辅助性T淋巴细胞17(Th17)/调节性T淋巴细胞(Treg)相关细胞因子对脓毒症合并多器官功能障碍综合征(MODS)患者的预后评估价值。方法本研究为前瞻性观察性研究。选择2023年1月至2025年5月在陕西省渭南市中心医院就诊的132例脓毒症合并MODS患者为研究对象,根据入院后28 d内存活情况分为死亡组(n=42)和存活组(n=90)。比较两组患者的一般资料及基线临床特征、NKT细胞比例及Th17/Treg相关细胞因子的表达水平。采用多因素logistic回归分析筛选脓毒症合并MODS患者死亡的独立影响因素,构建预后评估列线图模型。通过受试者操作特征(ROC)曲线及曲线下面积(AUC)评价预后评估模型的效能。结果死亡组患者的序贯器官衰竭评分(SOFA)、入院时体温、白细胞计数、C反应蛋白(CRP)、降钙素原(PCT)水平明显高于存活组患者,入院时收缩压、pH、NKT细胞比例、转化生长因子β(TGF-β)、白介素-10(IL-10)水平低于存活组,IL-17、IL-23水平高于存活组,差异均有统计学意义(P<0.05)。校正混杂因素后的多因素logistic回归分析表明,高IL-17、IL-23水平是脓毒症合并MODS患者死亡的独立危险因素,高NKT细胞比例、高TGF-β、IL-10水平是脓毒症合并MODS患者死亡的独立保护因素(P<0.05)。ROC分析显示,上述指标联合预测脓毒症合并MODS患者预后的曲线下面积为0.926,高于各指标独立预测的效能(P<0.001)。结论高Th17细胞相关细胞因子水平、低NKT细胞比例及低Treg细胞相关细胞因子水平均与脓毒症合并MODS患者的不良预后密切相关,基于上述因素构建的预后评估模型具有较好的准确性和预测效能。
Objective To investigate the prognostic value of NKT-like cell proportion combined with the T helper 17(Th17)/regulatory T cell(Treg)cytokine axis in patients with sepsis complicated by Multiple Organ Dysfunction Syndrome(MODS).Method This prospective observational study enrolled 132 sepsis patients with MODS admitted to Weinan Central Hospital between January 2023 and May 2025.Patients were categorized into a death group and a survival group based on 28-day mortality following admission.Differences in general clinical data,baseline characteristics,NKT-like cell proportion,and expression levels of Th17/Treg cytokines were compared between the two groups.Multivariate logistic regression analysis was employed to identify independent risk factors for mortality in sepsis patients with MODS,and a nomogram model for prognostic assessment was constructed.The performance of the prognostic model was evaluated using receiver operating characteristic(ROC)curve analysis and the area under the curve(AUC).Result The sequential organ failure assessment(SOFA)score,body temperature on admission,white blood cell count,C-reactive protein(CRP),and procalcitonin(PCT)levels were signifi cantly higher in the death group compared to the survival group.In contrast,systolic blood pressure on admission,pH,NKT-like cell proportion,transforming growth factor-beta(TGF-β),and interleukin(IL)-10 levels were lower in the death group,while IL-17 and IL-23 levels were higher(P<0.05).Multivariate logistic regression analysis adjusted for confounding factors identifi ed elevated levels of IL-17 and IL-23 as independent risk factors for mortality,whereas higher NKT-like cell proportion,TGF-β,and IL-10 levels were independent protective factors(P<0.05).ROC analysis demonstrated that the combined predictive model incorporating these independent factors achieved an AUC of 0.926,which was signifi cantly higher than the predictive power of any single factor alone(all P<0.001).Conclusion Higher levels of Th17-associated cytokines,along with lower NKT-like cell proportion and lower levels of Treg-associated cytokines,are closely associated with poor prognosis in sepsis patients with MODS.The prognostic assessment model constructed based on these factors exhibits good accuracy and effi cacy.
作者
吴水淼
罗晓瑛
甄丽芳
李媛媛
Wu Shuimiao;Luo Xiaoying;Zhen Lifang;Li Yuanyuan(Department of Respiratory and Critical Care Medicine,Weinan Central Hospital,Weinan Shaanxi 714000,China;Department of Respiratory and Critical Care Medicine,General Hospital of Ordnance Industry,Xi’an Shaanxi 710000,China;Department of Critical Care Medicine,Weinan Central Hospital,Weinan Shaanxi 714000,China)
出处
《中国医刊》
2026年第2期151-155,共5页
Chinese Journal of Medicine
基金
2024年陕西省卫生健康委高层次人才培育计划。
