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观察脓毒症急性肺损伤患者外周血Th17细胞水平与病情严重程度及预后的关系,探讨其在脓毒症急性肺损伤发生发展中的临床作用。以190例脓毒症患者为研究对象,按临床表现分为脓毒症普通组(110例)和脓毒症肺损伤组(80例)。根据脓毒症肺损伤患者病情严重程度将其分为低危组(29例)、中危组(28例)和高危组(23例);按脓毒症肺损伤患者临床结局将其分为存活组(64例)和死亡组(16例)。采用流式细胞仪检测各组外周血Th17细胞比例,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Th17细胞比例及APACHE Ⅱ评分水平的差异以及Th17细胞水平与APACHE Ⅱ评分的相关性,评价外周血Th17细胞水平对脓毒症肺损伤患者病情严重程度与临床预后的评估价值。结果显示脓毒症肺损伤组患者外周血Th17细胞及IL-17水平明显高于脓毒症普通组患者(P<0.05);低危组、中危组及高危组间外周血Th17细胞水平、IL-17及APACHE Ⅱ评分的差异具有统计学意义(P<0.05),其中,高危组外周血Th17细胞水平、IL-17及APACHE Ⅱ评分最高,中危组次之,低危组最低(P<0.05);死亡组外周血Th17细胞水平、IL-17及APACHE Ⅱ评分显著高于存活组(P<0.05)。相关性分析显示,血清外周血Th17细胞水平与APACHE Ⅱ评分(r=0.81,P=0.00)及死亡率(r=0.43,P=0.00)呈正相关。ROC曲线分析显示,外周血Th17细胞水平曲线下面积(ACU)为0.842(95%CI:0.784~0.908),其最佳工作点为7.0%,此时判断脓毒症肺损伤患者预后不良的敏感度和特异度分别为81.83%和86.82%。研究表明脓毒症急性肺损伤患者外周血Th17细胞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。
To observe the relationship between the level of Th17 cells in peripheral blood and the severity and prognosis of septic acute lung injury patients and to explore its clinical significance in the pathogenesis and development of acute lung injury induced by sepsis. 190 patients with sepsis as the research object, according to clinical manifestations were divided into sepsis group (110 cases) and septic lung injury group (80 cases). Patients were divided into low risk group (n = 29), intermediate risk group (n = 28) and high risk group (n = 23) according to the severity of septic lung injury. According to the clinical outcome of septic lung injury patients, Survival group (64 cases) and death group (16 cases). The proportion of Th17 cells in peripheral blood was measured by flow cytometry. The scores of acute physiology and chronic health status (APACHE Ⅱ) were also recorded. The differences of Th17 cell ratio and APACHE Ⅱ score, APACHE Ⅱ score of the correlation between the evaluation of peripheral blood levels of Th17 cells in patients with sepsis lung injury severity and clinical prognostic value. The results showed that the levels of Th17 cells and IL-17 in peripheral blood of patients with sepsis-induced lung injury were significantly higher than those of patients with sepsis (P <0.05). The levels of Th17 cells in peripheral blood of low-risk group, moderate-risk group and high- The levels of IL-17 and APACHE Ⅱ in the high-risk group were the highest, the middle-risk group was the second, the lowest was in the low-risk group (P <0.05) <0.05). The levels of Th17 cells, IL-17 and APACHE Ⅱ in the peripheral blood of the deceased group were significantly higher than those of the surviving group (P <0.05). Correlation analysis showed that there was a positive correlation between serum Th17 level and APACHE Ⅱ score (r = 0.81, P = 0.00) and mortality (r = 0.43, P = 0.00). ROC curve analysis showed that the area under the curve of Th17 cells in peripheral blood (ACU) was 0.842 (95% CI: 0.784-0.908), and the optimal operating point was 7.0%. At this time, the sensitivity of poor prognosis in patients with septic lung injury was judged Degree and specificity were 81.83% and 86.82% respectively. Studies have shown that the increase of peripheral blood Th17 cells in patients with acute lung injury with sepsis is closely related to the severity and prognosis of the disease, which can be used as a valid predictor and has certain clinical value.