Clinical significance and prognostic value of cellular immunity, inflammatory factors and myocardial enzymes in septic shock

Abstract

Objective To investigate the clinical significance of cellular immune function, inflammatory factors and myocardial enzyme detection in evaluation of prognosis of septic shock, so as to provide a reference for clinical diagnosis and treatment of septic shock. Methods From June 2015 to June 2018, 73 patients with septic shock treated in the First People's Hospital of Yongkang were selected as the research subjects.According to the 28d prognosis after the patients entered the ICU, the patients were divided into the death group and the survival group.Another 67 cases of health examination from June 2015 to June 2018 were selected as control group.The changes of T lymphocyte subsets includingCD3, CD4 and CD8 were measured by BD FACSCanto I I flow cytometry, the content of procalcitonin(PCT) was determined by immunoluminescence assay, the content of C-reactive protein(CRP) was determined by immunoturbidimetry, and the content of creatine kinase MB(CK-MB), cardiac troponin I(cTnI) and lactate dehydrogenase(LDH) was determined by enzymatic kinetics. Results The APACHE Ⅱ score and MODS score of the survival group and the death group were higher than those of the control group [(2.20±0.61)points and (4.86±1.29)points]. The APACHE Ⅱ score and MODS score of death group [(16.45±4.28)points and (27.63±4.97)points] were higher than those of survival group [(9.84±2.45)points and (19.84±3.28)points](all P<0.05). The CD3+, CD4+ and CD4+/CD8+ in the survival group and the death group were significantly lower than those in the control group[(71.32±6.96)%, (42.63±4.26)%, (1.67±0.31)%](all P<0.05). The contents of PCT and CRP in the survival group and the death group were higher than those in the control group [(0.19±0.03)ng/mL and (2.19±0.76)mg/L], and the contents of PCT [(15.93±3.26)ng/mL] and CRP [(184.32±29.80)mg/L] in the death group were higher than those in the survival group [(6.87±1.94)ng/mL and (69.49±17.42)mg/L] (all P<0.05). The CK-MB content in the survival group and the death group of septic shock was lower than that in the control group [(1.97±0.21)μg/L], and the cTnI and LDH contents were higher than that in the control group [(0.03±0.01)μg/L and (168.93±16.52)U/L], the content of CK-MB [(0.68±0.10)μg/L] in the death group was lower than that in the survival group [(1.27±0.13)μg/L], while the contents of cTnI [(0.39±0.06)μg/L] and LDH [(384.52±39.89)U/L] in the death group were lower than those in the survival group [(0.17±0.04)μg/L and (257.18±25.47)U/L] (P<0.05). Conclusion The immune function of the patients with septic shock is obviously reduced, there are obvious inflammatory reactions and abnormal myocardial enzymes, and the detection of cellular immune function, inflammatory factors and myocardial enzymes can be used as an effective index to judge the shock of septic shock. Key words: Shock, septic; Immunity, cellular; C-reactive protein; Creatine kinase, MB form; Troponin I; Lactate dehydrogenases; Prognosis