外周血CD64指数对创伤手术后脓毒症病情严重程度及预后的评估价值

摘要

Objective To observe the correlation between CD64 index levels in peripheral blood and the severity and prognosis factors of postoperative traumatic sepsis,and investigate the clinical effect of these changes in the development of postoperative traumatic sepsis.Methods A total of 560 patients with trauma were enrolled in the study,and these patients were divided into the postoperative traumatic sepsis group (210 cases) and the postoperative general trauma group (350 cases) according to clinical manifestations.According to the severity of the postoperative traumatic sepsis,these patients were divided into low-risk group (64 cases),moderate-risk group (75 cases) and high-risk group (71 cases).According to clinical prognosis,these patients with post-traumatic sepsis were divided into survival group (178 cases) and death group (32 cases).The CD64 index in peripheral blood and APACHE Ⅱ score were analyzed and measured by flow cytometry.The differences and correlation between CD64 index levels and APACHE Ⅱ score were compared and analyzed,and the relationship between CD64 index levels and the severity and prognosis of postoperative traumatic sepsis were also assessed.Results The CD64 index levels of postoperative traumatic sepsis group were higher than the postoperative general trauma group (P<0.05).The differences in terms of CD64 index,APACHE Ⅱ score and mortality rate among low-risk group,moderate-risk group and high-risk group were statistically significant,in which high-risk group was the highest,followed by moderate-risk group,and low-risk group was the lowest(P<0.05).Compared with the survival group,the death group had higher CD64 index levels and APACHE Ⅱ score (P<0.05).The CD64 index levels were positive correlated with APACHE Ⅱ score (r=0.72,P=0.00) and mortality (r=0.56,P=0.00).ROC curves analysis results showed that the area under curve of CD64 index was 0.874 (95%CI:0.765~0.896), and the optimal operating point was 7.08,which had 82.6% sensiticity and 86.4% specificity.Conclusion The increased CD64 index levels in postoperative traumatic sepsis are closely related to the severity and prognosis of disease,and the CD64 index levels can be effective predictor with some clinical application value.%目的 观察创伤手术后脓毒症患者外周血CD64指数水平与其病情严重程度及预后的关系,探讨其在创伤手术后脓毒症发生发展中的临床作用.方法 选择2012年2月至2015年10月大坪医院收治的560例创伤患者为研究对象,按临床表现分为创伤手术后脓毒症组(210例)和创伤手术普通组(350例),根据创伤手术后脓毒症患者病情严重程度将脓毒症组分为低危组(64例)、中危组(75例)和高危组(71例);按创伤手术后脓毒症患者临床结局将脓毒症组分为存活组(178例)和死亡组(32例).采用流式细胞仪检测各组外周血CD64指数同时记录急性生理学与慢性健康状况(APACHE Ⅱ)评分情况,分别比较各组外周血CD64指数及APACHE Ⅱ评分水平的差异以及CD64指数水平与APACHE Ⅱ评分的相关性,评价外周血CD64指数水平对创伤手术后脓毒症患者病情严重程度与临床预后的评估价值.结果 创伤手术后脓毒症组患者外周血CD64指数明显高于创伤手术普通组患者(P<0.05);低危组、中危组及高危组间外周血CD64指数水平、APACHE Ⅱ评分及死亡率的差异具有统计学意义(P<0.05),其中,高危组外周血CD64指数水平、APACHE Ⅱ评分及死亡率最高,中危组次之,低危组最低(P<0.05);死亡组外周血CD64指数水平和APACHE Ⅱ评分显著高于存活组(P<0.05).相关性分析显示,外周血CD64指数水平与APACHE Ⅱ评分(r=0.72,P=0.00)及死亡率(r=0.56,P=0.00)呈正相关.ROC曲线分析显示,以外周血CD64指数7.08为判断创伤手术后脓毒症患者预后不佳的临界值时,其敏感性和特异性分别为82.6%和86.4%,ROC曲线下面积(AUC)为0.874[95%CI(0.765~0.896)].结论 创伤手术后脓毒症患者外周血CD64指数水平的增加与其病情严重程度及预后密切相关,其可作为一项有效的预测指标,具有一定的临床应用价值.