严重创伤患者早期外周血淋巴细胞变化与预后之间的关系

doi:10.19723/j.issn.1671-167X.2022.03.023

摘要/Abstract

摘要：

目的: 探讨严重创伤早期外周血淋巴细胞变化趋势与预后间的关系。方法: 选取2017年6月至2020年6月北京大学人民医院创伤救治中心收治的严重多发伤患者作为研究对象进行回顾性研究, 观察入院后连续5 d血常规中淋巴细胞变化趋势并进行分组, 第1组: 淋巴细胞减少后在5 d内恢复正常; 第2组: 淋巴细胞减少后未恢复正常; 第3组: 淋巴细胞一直处于正常水平, 并记录各组患者在住院28 d后的转归情况。对收集的临床资料进行统计学分析, 了解创伤早期淋巴细胞变化趋势与预后间的关系。同时, 为排除年龄的影响, 依据年龄是否≥65岁进行分层, 并根据住院时间是否≥28 d分为住院时间延长组和住院时间非延长组, 在不同年龄组中分别探讨淋巴细胞变化与住院时间的关系。结果: 共纳入患者83例, 其中男性66例, 女性17例, 主要受伤机制为车祸伤和高处坠落伤, 创伤严重程度评分(injury severe score, ISS)为(30±11)分。根据连续5 d淋巴细胞变化趋势分组, 第1组32例, 第2组33例, 第3组18例。第2组33例患者中, 在住院28 d内死亡5例, 死亡率为15.2%(5/33), 未出院9例, 均高于其他两组(P < 0.05)。进一步按年龄进行分层后, 发现在高年龄患者中淋巴细胞处于低水平是住院时间≥28 d的危险因素, 但在低年龄患者中, 发现中性粒细胞持续偏高与预后不良相关。结论: 严重创伤后外周血淋巴细胞一直处于低水平与预后不佳密切相关, 尤其在高年龄患者中明显, 淋巴细胞可作为一项可靠指标用于预后评估。

关键词: 严重创伤, 淋巴细胞减少, 适应性免疫, 全身炎症反应综合征

Abstract:

Objective: To investigate the relationship between early lymphocyte responses and the prognosis in severely injured patients. Methods: Consecutive patients with severe trauma who were treated in Peking University People′s Hospital Trauma Medical Center between June 2017 and June 2020 were enrolled in this restropective chart-review study. According to the responses of lymphocyte after severe injury, the patients were divided into three groups, group 1: lymphopenia-returned to normal; group 2: persistent lymphopenia; group 3: never lymphopenic, and the outcome of 28 d were recorded. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow coma scale (GCS), injury severity score (ISS) and massive blood transfusion were collected. Perform statistical analysis on the collected clinical data to understand the trend of lymphocyte changes in early trauma and the relationship with prognosis. In order to eliminate the interference of age, stratification was carried out according to whether the age was ≥ 65 years old, in different age groups, they were grouped according to whether the length of stay was ≥ 28 d, and the relationship between lymphocyte trend and length of stay was discussed. Results: A total of 83 patients were included, 66 males and 17 females. The main injury mechanisms were traffic accident injuries and high-altitude fall injuries. The average ISS was (30±11) points. 65 patients had lymphopenia on the day of injury, 32 of them returned to normal on the 5th day, and the rest did not recover; the other 18 patients had normal lymphocyte levels after injury. Patients which are failure to normalize lymphopenia within the first 5 days following admission was related with the long hospitalization time and higher 28 d mortality rate. After further stratification by age, failure to normalize lymphopenia within the first 5 days following admission in the elderly group (age ≥65 years) was a risk factor for prolonged hospital stay (≥28 d), P=0.04. While in younger group, a high level of neutrophils within the first 5 d following admission was a risk factor for bad outcome. Conclusion: A failure to normalize lymphopenia in severely injured patients is associated with significantly higher mortality and longer hospital stay. This study reveals lymphocytes can be used as a reliable indicator for the prognostic evaluation.

Key words: Severe trauma, Lymphopenia, Innate immunity, Systemic inflammatory response syndrome

中图分类号:

R641

郭辅政,赵秀娟,邓玖旭,杜哲,王天兵,朱凤雪. 严重创伤患者早期外周血淋巴细胞变化与预后之间的关系[J]. 北京大学学报（医学版）, 2022, 54(3): 552-556.

Fu-zheng GUO,Xiu-juan ZHAO,Jiu-xu DENG,Zhe DU,Tian-bing WANG,Feng-xue ZHU. Early changes within the lymphocyte population are associated with the long term prognosis in severely injured patients[J]. Journal of Peking University (Health Sciences), 2022, 54(3): 552-556.

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参考文献 18

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Variable	Value
Age/years, ${\bar x}$±s	50±17
Gender, n (%)
Male	66(79.5)
Female	17(20.5)
Mechanism of injury, n (%)
Traffic injury	37(44.6)
High falling injury	30(36.1)
Tumbles injury	6(7.2)
Blast injury	2(2.4)
ISS, ${\bar x}$±s	30±11
GCS, M(P₂₅, P₇₅)	10 (3, 15)
Lactate/(mmol/L), ${\bar x}$±s	2.7±2.1
Base excess/(mmol/L), ${\bar x}$±s	-3.9±3.6
Cell count/ (× 10⁹/L), ${\bar x}$±s
Neutrophils on arrival	11.02±4.47
Lymphocytes on arrival	1.01±0.52
Massive blood transfusion, n(%)	34 (41.1)
Los/d, ${\bar x}$±s	22±16
28 d mortality, n (%)	5 (6)

Variable	Group 1 (n=32)	Group 2 (n=33)	Group 3 (n=18)	P
Lymphocyte count /(×10⁹/L), ${\bar x}$±s	1.12±0.06	0.58±0.21^*Δ	1.25±0.24	< 0.001
Age/years, ${\bar x}$±s	42±14	59±13^*Δ	48±19	< 0.001
Gender, n				0.699
Male	26	27	13
Female	6	6	5
ISS, ${\bar x}$±s	30±12	32±11	27±10	0.282
GCS, M(P₂₅, P₇₅)	15(12, 15)	13(10, 15)	15(14, 15)	0.062
Lactate/(mmol/L), ${\bar x}$±s	2.46±2.29	3.27±2.33	2.13±1.27	0.141
Base excess/(mmol/L), ${\bar x}$±s	-4.01±3.34	-4.49±3.44	-3.06±4.46	0.414
Massive blood transfusion, n	12	16	6	0.370
Los/d, ${\bar x}$±s	19±10	23±11^Δ	15±9	0.034
Outcome of 28 d, n				0.004
Discharge	28	19	16
Hospital	4	9	2
Died	0	5	0

Items	Los < 28 d	Los≥28 d	OR	95%CI	P
Age < 65 years, n	45	13
Neutrophils
Return to normal, n	42	2	1
Remains elevated, n	3	11	10.18	2.66-38.89	0.001
Lymphocyte
Return to normal, n	32	5	1
Remains low, n	13	8	3.93	1.08-14.31	0.067
Age≥65 years, n	13	7
Neutrophils
Return to normal, n	10	5	1
Remains elevated, n	3	2	0.56	0.05-6.63	0.82
Lymphocyte
Return to normal, n	12	1	1
Remains low, n	1	6	2.81	1.18-6.78	0.04

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