Analysis Of Clinical Features Of Immune Disorders Related To Septic Shock In Children

Objectives:To study the characteristics of immune disorders in children with septic shock,to explore the evolution of immune disorders in septic shock during the development of the disease,and to evaluate the diagnostic value of peripheral blood lymphocyte subsets and humoral immunity for septic shock and sepsis.Whether the two can provide reference for the early warning and clinical diagnosis and treatment of patients with septic shock and sepsis.Methods:The 65 cases of septic shock children admitted to the Kunming Children’s Hospital PICU from January 2018 to December 2020 were selected as the experimental group,and 134 children with sepsis and 76 children with healthy physical examination during the same period were selected as the control group.Collect general data,clinical characteristics,laboratory test data(including lymphocyte subsets,humoral immunity,inflammatory indicators,blood biochemistry,etc.),clinical scores(APACHE II,SOFA score),treatment status,and 28-day outcome of the research subjects.Statistical software SPSS 24.0 was used to sort and analyze the data.Results:1.Clinical features:(1)The 28-day survival rate of 65 children with septic shock in this study was 66.2%,and the mortality rate was 33.8%.The main pathogenic bacteria in the septic shock group and the sepsis group were gram-positive cocci,followed by gram-negative bacteria.From the point of view of the main source of infection,the septic shock group was predominantly with abdominal cavity infection,and the sepsis group was predominantly with respiratory tract infection.The most common organ dysfunction associated with septic shock in children is myocardial injury and liver damage.(2)In this study,64.6%of children with septic shock required ventilator-assisted ventilation,with an average mechanical ventilation time of 142.6 hours;16.9%of children with septic shock improved their circulatory disturbances after volume expansion,while the rest needed One or more vasoactive drugs are used to maintain tissue perfusion.2.Features of immune disorders:(1)Comparative analysis of the peripheral blood lymphocyte subpopulations between the septic shock group,the sepsis group and the healthy child group.The results showed that the percentage of CD3+T cells and the percentage of CD3+CD4+T cells were statistically compared among the three groups.There was a statistical difference(P<0.05)according to the severity of the disease;the percentage of CD19+B cells was statistically different among the three groups(P<0.05),and it showed an upward trend according to the severity of the disease;the septic shock group The percentage of CD16+CD56+cells in the children was significantly lower than the sepsis group and the healthy child group,and the difference was statistically significant(P<0.05),but there was no difference between the sepsis group and the healthy child group(P>0.05)).(2)Comparative analysis of the humoral immunity between the three groups showed that the levels of IgG,C3,and C4 in the septic shock group were significantly lower than those in the sepsis group and the healthy child group,and the difference was statistically significant(P<0.05).(3)Analyze the difference in related indicators between the survival group and the death group of children with septic shock.The results show that the APACHE II score,SOFA score,the type of vasoactive drugs used in the death group,ferritin,lactic acid,BE,AST,LDH,CK,CK-MB,serum creatinine,myoglobin,high-sensitivity troponin,serum potassium,INR,APTT and other related indicators were significantly higher than the survival group,the difference was statistically significant(P<0.05);PLT,blood gas in the death group The PH value was significantly lower than that of the survival group,and the difference was statistically significant(P<0.05);however,there were no statistical differences in lymphocyte subsets and humoral immunity between the two groups(P>0.05).3.Correlation analysis of immune disorders:(1)Through logistics regression analysis,it is found that IgG and C3 are risk factors that affect the aggravation of sepsis.The concentration of IgG and C3 is negatively correlated with the progression of sepsis to septic shock(IgG:OR=0.827,P=0.003;C3:OR=0.133,P=0.002),that is,the lower the concentration of IgG and C3,the greater the risk of exacerbation of sepsis.The ROC curve is used to evaluate the diagnostic value of lymphocyte subsets for sepsis.The results show that the area under the curve of the percentage of CD19+ B cells is 0.759,which has a certain predictability.(2)Pearson correlation analysis results show that APACHE Ⅱ score is negatively correlated with CD3+CD4+T cells,CD4+/CD8+,and positively correlated with CD3+CD8+T cells;SOFA score is negatively correlated with CD4+/CD8+,Showed positive correlation with CD3+CD8+T cells;APACHE Ⅱ score and SOFA score were negatively correlated with C3 and C4,APACHE Ⅱ score,SOFA score were not correlated with IgG,IgM and IgA(P>0.05).(3)By analyzing the correlation between immune indexes and inflammatory indexes in children with septic shock,the results showed that the percentage of CD3+T cells and the percentage of CD3+CD4+CD8+T cells were positively correlated with ferritin,and CD19+B The percentage of cells is negatively correlated with ferritin.IgA is positively correlated with WBC,and C3 is negatively correlated with WBC,ferritin,and PCT.There was no correlation between other immune indexes and inflammatory indexes(P>0.05).(4)Through Pearson correlation analysis of the correlation between lymphocyte subsets and organ dysfunction,the analysis results show that there is no correlation between organ dysfunction and cellular immune status;liver function damage is positively correlated with IgG and IgA,and C3 There is a negative correlation;renal function injury is positively correlated with IgA,and negatively correlated with C4(P<0.05);myocardial injury is negatively correlated with C3 and C4(P<0.05);coagulation dysfunction is negatively correlated with C3 and C4(P<0.05).Conclusions:1.Both septic shock and sepsis in children have cellular and humoral immune disorders,and the immune disorders of septic shock are more serious.2.With the aggravation of sepsis,the cellular immune disorder is manifested by the gradual exhaustion of CD4+T cells and NK cells,and the proliferation and activation of CD19+B cells.3.There are obvious B lymphocyte dysfunction and complement system disorders in septic shock,which is manifested as a significant decrease in the concentration of IgG,C3,and C4,and the degree of decrease is negatively correlated with the SOFA score and APACHE Ⅱ score.In addition,the declines of IgG and C3 are risk factors for septic shock.4.The excessive activation and consumption of complement are closely related to the damage of organ function.5.SOFA score and APACHE Ⅱ score have high value for the evaluation of the condition and prognosis of patients with sepsis and septic shock.6.Monitoring WBC,ferritin,PCT and other inflammatory indicators in clinical work has certain significance for evaluating the immune status of patients with sepsis and septic shock.