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目的:研究尿源性脓毒血症早期淋巴细胞亚群计数以及相关指标改变,希望为临床提高尿源性脓毒血症的早期诊断提供依据。方法:纳入2016-03-2017-04在我科住院的31例尿源性脓毒血症患者作为尿脓毒血症组,29例全身炎症反应综合征(SIRS)患者作为SIRS组,35例健康人作为对照组。对3组第一时间血象、降钙素原、淋巴细胞亚群、凝血酶时间以及相关评分等进行测定和比较,全部病例于入院治疗后、使用抗菌药物前的24h内测定。结果:CD4、降钙素原、CD3、淋巴细胞在诊断尿源性脓毒血症的效能方面相似,其中敏感度最高的为CD3(截断值728,敏感度69.0%);特异性最高的为降钙素原(截断值2.54,特异性82.8%);最优诊断是CD3&CD4,敏感性和特异性分别为71.0%和72.4%。SIRS组和尿脓毒血症组与APACHEⅡ评分均有相关性的是CD比值、红细胞、凝血酶原时间、国际标准化比值。结论:淋巴细胞亚群计数对于尿源性脓毒血症的诊断敏感性和特异性明显高于降钙素原,同时发现淋巴细胞亚群计数和红细胞计数在间接反映尿源性脓毒血症严重程度方面具有一定的临床作用。
OBJECTIVE: To study the changes of early lymphocyte subsets in urine-derived sepsis and the related indicators, and to provide evidence for the clinical diagnosis of early urinary sepsis. Methods: Totally 31 patients with urinary sepsis hospitalized in our department were enrolled in 2016-03-2017-04 as the urine sepsis group, 29 patients with systemic inflammatory response syndrome (SIRS) as the SIRS group and 35 patients Healthy people as a control group. The blood samples, procalcitonin, lymphocyte subsets, thrombin time and related scores of the three groups were measured and compared at the first time. All patients were measured within 24 hours before the use of antibacterial drugs after admission. Results: CD4, procalcitonin, CD3 and lymphocytes were similar in the diagnosis of urinary sepsis. CD3 with the highest sensitivity (cutoff 728, sensitivity 69.0%) and the highest specificity was Procalcitonin (cut-off value 2.54, specificity 82.8%); the optimal diagnosis was CD3 & CD4 with a sensitivity and specificity of 71.0% and 72.4%, respectively. SIRS group and urinary sepsis group and APACHE Ⅱ score are related to the CD ratio, erythrocyte, prothrombin time, the international standardization ratio. Conclusions: The sensitivity and specificity of lymphocyte subsets counts for the diagnosis of urinary sepsis are significantly higher than that of procalcitonin, and lymphocyte subsets count and red blood cell count indirectly reflect urinary sepsis Severity has a certain clinical role.