脓毒症患儿免疫抑制与多器官功能障碍相关性研究

摘要

Objective To analyse the relationship between immunosuppression and severity of sepsis in children,thus to explore the role of immunity in the progression of sepsis and provide a reference for the treatment of sepsis in children.Methods In this retrospective study,375 children with sepsis were included.Blood specimens were collected for the analysis of lymphocyte subsets and humoral immunity in 24 hours after admission into ICU.Univariate analysis was performed between immunity indices and organ dysfunction.Logistic stepwise regression was used to screen out the risk factors of multiple organ dysfunction (MKDS) and mortality.Results Sepsis children were divided into three groups,no organ dysfunction,single organ dysfunction and multiple organ dysfunction.NK cell percentage,CD4/CD8 and C3 were different among three groups,and significantly lower in MODS children.Multivariate analysis showed decreased CD4/CD8 (OR=0.66,95％CI:0.51-0.85).C3 level (OR=0.20,95％CI:0.10-0.42) were associated with MODS.CNS infection (OR=2.54,95％CI:1.35-4.77) and pneumonia infection (OR=2.29,95％CI:1.36-3.83) were also risk factors of MODS.Depletion of C3 (OR=0.26,95％CI:0.09-0.76) and pneumonia infection (OR=2.61,95％CI:1.12-6.09) were risk factors of mortality.Conclusions CD4/CD8 and complement C3 were significantly decreased in sepsis children with MODS,immunosuppression may play an important role in the development of MODS in children with sepsis.Baseline CD4/CD8 and C3 level could be potential prognostic markers of sepsis.%目的 研究脓毒症患儿免疫水平与病情严重程度的相关性,探讨免疫抑制对器官功能损害的影响.方法 回顾分析375例脓毒症患儿的临床资料,分析患儿转入重症监护室24小时内免疫功能指标与器官损害数之间的关系;Logistic逐步回归分析发生多器官功能障碍综合征(MODS)及院内死亡的风险因素.结果 375例脓毒症患儿中位年龄8.7个月(1个月～13岁),男228例、女147例,男女比例约1.55∶1.依据治疗期间发生功能障碍的器官数目,将脓毒症患儿分为无器官功能障碍组、单器官功能障碍组及多器官功能障碍组.三组间NK细胞百分比,CD 4/CD8比值,补体C3、C4水平的差异均有统计学意义(P＜0.05),以多器官功能障碍组最低.Logistic多因素回归分析显示,CD 4/CD8比值(OR=0.66,95％CI:0.51～0.85)、补体C3(OR=0.20,95％ CI:0.10～0.42)、中枢神经系统感染(OR=2.54,95 ％CI:1.35～4.77)和肺部感染(OR=2.29,95 ％CI:1.36～3.83)是MODS发生的影响因素;补体C3(OR=0.26,95 ％CI:0.09～0.76)及肺部感染(OR=2.61,95％CI:1.12～6.09)为脓毒症患儿院内死亡的影响因素.结论 脓毒症患儿的免疫抑制与MODS发生有相关性,CD 4/CD8比值降低以及补体C3消耗可作为评估脓毒症患儿MODS发生风险的免疫学指标.