共刺激分子CD86对急诊脓毒症发生的预测价值

摘要 目的：：探讨共刺激分子CD86评估急诊感染患者发生脓毒症的价值。方法：以2019年9月至2020年9月上海交通大学医学院附属仁济医院急诊科监护室和病房收治的年龄≥18岁且存在感染或临床高度怀疑感染的患者为研究对象。按照Sepsis-3.0标准，将患者分为脓毒症组和非脓毒症组。记录所有患者的临床资料，入院时24小时内检测所有患者的静脉血血常规、外周血单核细胞（PBMC）的CD86和HLA-DR表达水平、C反应蛋白（CRP）、降钙素原（PCT）、白蛋白（ALB）、乳酸(Lac)、血清白介素水平，计算CRP/ALB比值、中性粒细胞/淋巴细胞比值(NLR)，血小板/淋巴细胞比值(PLR)，淋巴细胞/单核细胞比值(LMR)并记录。组间比较上述各指标的差异，然后进一步采用Logistics回归模型进行多因素分析。结果：入选患者共91例，脓毒症患者49例（死亡15例，占30.6%），非脓毒症患者42例（0死亡）；脓毒症组CD86%、N（中性粒细胞）、CRP/ALB、NLR、IL-6、IL-10、SIL-2R、CRP、PCT均高于非脓毒症感染（P<0.05），而HLA-DR、LY（淋巴细胞）、PLT（血小板）、ALB、LMR在脓毒症组中则较非脓毒症组降低（P<0.05）。多因素Logistics回归分析建立CD86模型和HLA-DR模型，发现在CD86模型中，CD86，呼吸频率（RR），LY，PCT是发生脓毒症的独立预测因子（P<0.05），OR值分别为1.539(1.148-2.064)，1.141(1.009-1.290)，0.280(0.097-0.811)和1.036(1.005-1.068)；在HLA-DR模型中，HLA-DR和LY是发生脓毒症的独立预测因子（P<0.05），OR值分别为0.971(0.953-0.988)和0.290（0.117-0.718）。最后将CD86模型、HLA-DR模型和APACHII评分进行ROC曲线分析，曲线下面积（AUC）分别为0.870（0.796-0.944）、0.793（0.700-0.887）、0.754（0.653-0.855）。结论：脓毒症患者PBMC的CD86水平升高，HLA-DR水平降低，CD86和HLA-DR可以早期预测急诊脓毒症的发生。

The Predictive Value of Co-stimulatory Molecule CD86 on the Occurrence of Emergency Sepsis

ABSTRACT Objective: To investigate the value of co-stimulatory molecule CD86 in evaluating sepsis in emergency infected patients. Methods: Patients who were18 years or older and had infection or were clinically highly suspected of infection admitted to the emergency intensive care unit and wards of Renji Hospital(affiliated to Shanghai Jiaotong University School of Medicine) between September 2019 to September 2020 were prospectively observed. According to the Sepsis 3.0, patients were divided into a sepsis group and a non-sepsis group. We recorded the clinical data of all patients, and checked all their complete blood cell, peripheral blood mononuclear cell (PBMC) CD86 and HLA-DR expression level, C-reactive protein (CRP), procalcitonin (PCT), albumin (ALB), lactic acid (Lac), serum interleukin level and calculation of CRP/ALB ratio, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte cell ratio (LMR) within 24 hours of admission. We compared the differences of the above indicators between the groups, and then further use the Logistics regression model for multivariate analysis. Results: A total of 91 patients were enrolled: 49 sepsis patients (15 deaths, 30.6%), 42 non-sepsis patients (0 deaths). In the sepsis group, the levels of CD86%, Neutrophils(N), CRP/ALB, NLR, IL-6, IL-10, SIL-2R, CRP, PCT were significantly higher than in the non-sepsis group (P<0.05), while HLA-DR, LY (lymphocytes), PLT (Platelets), ALB and LMR were significantly lower in the sepsis group than in the non-sepsis group (P<0.05). Multivariate Logistics regression analysis established the CD86 model and HLA-DR model, and found that in the CD86 model, CD86, respiration rate(RR), LYand PCT were independent predictors for sepsis (P<0.05), and the OR values were 1.539(1.148-2.064), 1.141(1.009-1.290), 0.280(0.097-0.811)and 1.036 (1.005-1.068), respectively. In the HLA-DR model, HLA-DR and LY were found to be independent predictors for sepsis (P<0.05), with OR values of 0.971(0.953-0.988) and 0.290(0.117-0.718). Finally, the CD86 model, HLA-DR model and APACHII score were analyzed by ROC curve, and the areas under the curve (AUC) were 0.870 (0.796-0.944), 0.793 (0.700-0.887), 0.754 (0.653-0.855), respectively. Conclusion: The CD86 of PBMC in sepsis patients is increased, and HLA-DR is decreased. CD86 and HLA-DR can be used as early predictors for the occurrence of emergency sepsis.