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目的:观察创伤患者淋巴细胞CD4+/CD8+比值及单核细胞HLA-DR%(mHLA-DR%)变化规律,探讨其与临床预后的关系及意义。方法:收集分析2010-01-2015-12期间东莞市第五人民医院救治的严重创伤患者(AIS-ISS评分≥16分且APACHEⅡ>15分),生存组31例,死亡组18例。分析两组入院时年龄、性别构成、AIS-ISS评分,APACHEⅡ评分、致伤因素(冲击伤、坠落伤、锐器伤、烧烫伤)、受伤部位(头颈部、胸部、腹部、盆腔、四肢)、血清降钙素原(Procalcitonin,PCT)浓度、CD4+/CD8+比值和mHLA-DR%,观察记录两组患者第1、3和7天APACHEⅡ评分、CD4+/CD8+比值和mHLA-DR%的变化并分析两组间差异,使用Pearson系数评估CD4+/CD8+比值和mHLA-DR%与APACHEⅡ评分之间的相关性,采用ROC曲线及Cox回归分析评估联合CD4+/CD8+比值和mHLA-DR%对严重创伤患者临床结局的预判作用和价值。结果:两组患者入院情况分析比较,差异无统计学意义。两组患者mHLA-DR%和CD4+/CD8+比值分别与APACHEⅡ呈负相关性(P<0.05),且各组内APACHEⅡ和mHLA-DR%、CD4+/CD8+比值前后变化,差异有统计学意义(P<0.05)。与存活组相比较,死亡组mHLA-DR%和CD4+/CD8+比值在第3天开始出现下降(P<0.05)。分别以第3天mHLA-DR%、CD4+/CD8+比值和二者联合绘制ROC曲线,结果显示两项指标联合曲线总面积最大,可达0.801(95%CI:0.773~0.882)。Cox回归分析显mHLA-DR%联合CD4+/CD8+比值预测严重创伤患者死亡的OR值为7.742(95%CI:5.693~8.338)。结论:严重创伤后CD4+/CD8+比值与mHLA-DR%呈现动态变化,两项指标不仅与病情的严重程度直接相关,也是预测死亡的危险因素,对严重创伤患者结局预判具有重要作用,对指导创伤临床救治具有一定价值。
Objective: To observe the changes of lymphocyte CD4 + / CD8 + ratio and monocyte HLA-DR% (mHLA-DR%) in trauma patients, and to explore its relationship with clinical prognosis. Methods: The patients with severe traumatic injury (AIS-ISS score≥16 and APACHEⅡ> 15) who were treated in Dongguan Fifth People’s Hospital during 2010-01-2015-12 were collected and analyzed. There were 31 survivors and 18 deaths. The age, sex composition, AIS-ISS score, APACHEⅡscore, injury factors (impact injury, fall injury, sharps injury, burns and scalds), injury site (head and neck, chest, abdomen, pelvis and limbs ), Serum Procalcitonin (PCT) concentration, CD4 + / CD8 + ratio and mHLA-DR%. The change of APACHEⅡscore, CD4 + / CD8 + ratio and mHLA-DR% on the 1st, 3rd and 7th day The differences between the two groups were analyzed. The Pearson coefficient was used to evaluate the correlation between CD4 + / CD8 + ratio and mHLA-DR% and APACHEⅡscore. The ROC curve and Cox regression analysis were used to evaluate the association between CD4 + / CD8 + ratio and mHLA-DR% The prognostic role and value of the patient’s clinical outcome. Results: The two groups of patients admitted to hospital analysis and comparison, the difference was not statistically significant. The ratios of mHLA-DR% and CD4 + / CD8 + were negatively correlated with APACHEⅡ (P <0.05), and the ratios of APACHEⅡ, mHLA-DR% and CD4 + / CD8 + <0.05). Compared with the survival group, the ratio of mHLA-DR% and CD4 + / CD8 + in the death group began to decrease on the 3rd day (P <0.05). The ROC curves of mHLA-DR%, CD4 + / CD8 + and their combination were plotted on day 3, respectively. The results showed that the combined area of the two indexes reached the maximum, reaching 0.801 (95% CI: 0.773-0.882). Cox regression analysis showed that the odds ratio of mHLA-DR combined with CD4 + / CD8 + ratio was 7.742 (95% CI: 5.693-8.338). Conclusion: The ratio of CD4 + / CD8 + and mHLA-DR% after severe trauma have dynamic changes. The two indexes are not only directly related to the severity of the disease, but also predict the risk of death, which plays an important role in predicting the outcome of severe traumatic patients. Clinical treatment of trauma has a certain value.