2020 年第 2 期 第 15 卷

合并持续炎症-免疫抑制-分解代谢综合征的重症监护病房长期住院患者免疫代谢及预后特征

Immune metabolism characteristics and prognosis of long-term hospitalized patients with persistent inflammation-immunosuppression-catabolic syndrome in intensive care unit

作者：张艳军楚磊童珊珊郑伟钟吉文赵灵

英文作者：

单位：广东省珠海市人民医院重症医学科519000

英文单位：

关键词：持续炎症-免疫抑制-分解代谢综合征；重症监护病房；长期住院；免疫代谢；炎性因子

英文关键词：

• 摘要：

• 【摘要】目的    探讨合并持续炎症-免疫抑制-分解代谢综合征（PICS）的重症监护病房（ICU）长期住院患者的免疫代谢及预后特征。方法    选取2015年6月至2017年6月入住广东省珠海市人民医院ICU 10 d以上的82例患者作为研究对象，参考PICS诊断标准分为PICS组（47例）和无PICS组（35例）。测定2组患者血清炎性因子（C反应蛋白、降钙素原）、T淋巴细胞（CD+3、CD+4、CD+8、CD+4/CD+8比值）水平；记录30 d、90 d院内感染率及生存率。结果    PICS组C反应蛋白和降钙素原水平均明显高于无PICS组［（51.2±9.4）mg/L比（6.7±1.5）mg/L、（11.3±0.5）μg/L比（4.6±0.4）μg/L］,差异均有统计学意义（均P＜0.001）。PICS组CD+3、CD+4、CD+4/CD+8比值明显低于、CD+8明显高于无PICS组［（53.2±2.6）%比（65.3±3.5）%、（27.9±3.5）%比（34.7±4.1）%、（1.58±1.21）比（2.08±0.17）、（24.7±3.2）%比（20.4±3.1）%］，差异均有统计学意义（均P＜0.001）。PICS组30 d、90 d院内感染率明显高于无PICS组［12.8%（6/47）比5.7%（2/35）、23.4%（11/47）比14.3%（5/35）］，30 d生存率明显低于无PICS组［57.4%（27/47）比82.9%（29/35）］，差异均有统计学意义（均P＜0.05）。2组90 d生存率比较差异无统计学意义（P＞0.05）。结论    ICU长期住院患者中，合并PICS者常伴有炎性因子、免疫水平异常，院内感染率较高，生存率较低。

• 【Abstract】Objective    To analyze the characteristics of immune metabolism and prognosis in long-term hospitalized patients with persistent inflammation-immunosuppression-catabolic syndrome（PICS） in intensive care unit（ICU）. Methods    A total of 82 patients admitted to ICU for more than 10 days were enrolled from June 2015 to June 2017 in Zhuhai People′s Hospital, Guangdong Province. According to the diagnostic criteria of PICS, all patients were divided into PICS group(47 cases) and non-PICS group(35 cases). Serums levels of inflammatory factors（C-reactive protein, procalcitonin） and T lymphocytes（CD+3, CD+4, CD+8, CD+4/CD+8） were detected. The 30 d and 90 d in-hospital infection rates and survival rates were observed. Results    Levels of serum C-reactive protein and procalcitonin in the PICS group were significantly higher than those in the non-PICS group［（51.2±9.4）mg/L vs （6.7±1.5）mg/L, （11.3±0.5）μg/L vs （4.6±0.4）μg/L］（both P＜0.001）. Levels of CD+3, CD+4, CD+4/CD+8 in the PICS group were significantly lower and CD+8 level was higher than those in the non-PICS group［（53.2±2.6）% vs （65.3±3.5）%, （27.9±3.5）% vs （34.7±4.1）%, （1.58±1.21） vs （2.08±0.17）, （24.7±3.2）% vs （20.4±3.1）%］（all P＜0.001）. The 30 d and 90 d in-hospital infection rates in the PICS group were significantly higher and the 30 d survival rate was lower than those in the non-PICS group［12.8%（6/47） vs 5.7%（2/35）, 23.4%（11/47） vs 14.3%（5/35）, 57.4%（27/47） vs 82.9%（29/35）］（all P＜0.05）. There was no significant difference of the 90 d survival rate between groups(P＞0.05). Conclusion    Long-term hospitalized patients in ICU who suffer from PICS are associated with abnormalities in inflammatory factors and immune response, high in-hospital infection rate and poor survival.