The Study Of Relationship Between Immune Status And Microvascular Injury Or Between Immune Status And Inflammation In Sepsis

Objective:to monitor the dynamic changes of Treg/CD4+ T ratio,angiopoietin-2,E-selectin,serum amyloid A and soluble CD 14 in peripheral blood of patients with sepsis,and to study their clinical significance and correlation,so as to make a more comprehensive diagnosis of sepsis,so as to reflect the immune status indicators from the commonly used clinical microvascular injury,inflammation indicators,and to provide reference for the future clinical sepsis immune monitoring and treatment timing of immunotherapy intervention.Methods:40 sepsis patients who met the sepsis 3.0 diagnostic criteria in the emergency ICU of the First Affiliated Hospital of Dalian Medical University from June 2020 to December 2020 were selected as the experimental group,and 20 healthy adults in our hospital during the same period were selected as the control group.The experimental group was divided into survival group(n=26)and death group(n=14)according to 28 day survival.In the experimental group,peripheral blood was collected on the day of diagnosis,the third day and the seventh day,and Treg/CD4+T,Ang-2 E-selectin,SAA and sCD14 were detected.On the day of diagnosis,other clinical data,APACHE Ⅱscore and SOFA score were collected.In the control group,blood was collected on the day of admission,and Treg/CD4+T,Ang-2 E-selectin,SAA and sCD14 were detected,and clinical data were collected.Treg/CD4+T was detected by flow cytometry,Ang-2,E-selectin,SAA and sCD14 were detected by ELISA.Objective to study the differences of Treg/CD4+T,Ang-2,E-selectin,SAA,sCD/4 between the experimental group and the control group,and the differences between the death group and the survival group,and to study the correlation between Treg/CD4+T and the last four indexes,so as to clarify the relationship between Treg/CD4+T and 28 day prognosis of patients.SPSS 24.0 was used for statistical analysis.Results:1.There were no significant differences in age and gender between the experimental group(n=40)and the control group(n=20)(all P>0.05),but there were significant differences in PCT and CRP(all P<0.05).The APACHE II score and SOFA score of the experimental group were 12.50 ± 5.738 and 6.20±3.048,respectively.The experimental group and the control group had baseline comparability.2.The Treg/CD4+T ratio of the experimental group was higher than that of the control group,and the difference was statistically significant(P<0.05).3.The serum Ang-2 and E-selectin values of the experimental group were higher than those of the control group,and the difference was statistically significant(P<0.05).4.The serum SAA and sCD14 values of the experimental group were higher than those of the control group,and the difference was statistically significant(P<0.05).5.The ratio of Treg/CD4+T in the death group was higher than that in the control group,and the difference was statistically significant(P<0.05).6.The values of serum Ang-2 and E-selectin in the death group were higher than those in the control group,and the difference was statistically significant(P<0.05).7.SAA and sCD14 values of death group were higher than those of control group,and the difference was statistically significant(P<0.05).8.There was no correlation between Treg/CD4+T ratio and serum E-selectin,SAA,sCD14 values(P>0.05).There was no correlation between Treg/CD4+ T ratio and serum Ang-2 values on day 1 and 7(P>0.05).There was correlation between Treg/CD4+T ratio and serum Ang-2 values on day 3(P<0.05),r=0.332.9.The ratio of Treg/CD4+T on day 1,3 and 7 had predictive value for 28 day mortality in patients with sepsis(all P<0.05).The AUC of Treg/CD4+T ratio on day 7 for 28 day mortality of sepsis patients was the largest,which was 0.769,and the best cut-off value was 6.55%(Youden index was 57.7%,sensitivity was 100%,specificity was 57.7%).Conclusion:1.Sepsis patients are generally in the state of immunosuppression,with microvascular damage and inflammatory reaction.The more severe the immunosuppression,microvascular damage and inflammatory reaction,the greater the risk of death within 28 days.2.The level of Ang-2 was positively correlated with the ratio of Treg/CD4+T on the third day of sepsis,which reflected the degree of immunosuppression to a certain extent.The higher the level of Ang-2,the more severe the immunosuppression.3.Treg/CD4+T ratio has a certain predictive value for 28 day mortality of patients with sepsis,and the predictive value is relatively highest on the 7th day.