Using surface molecule expression on lymphocytes to classify septic shock patients
Using surface molecule expression on lymphocytes to classify septic shock patients
复制标题
利用淋巴细胞表面分子表达对感染性休克患者进行分类
作者：
J. Monserrat;R. de Pablo;A. Prieto;Eduardo Reyes;Melchor Álvarez
与 McDunn 和 Hotchkiss [1] 一致，我们假设同时分析不同免疫系统细胞亚群将改善脓毒性休克患者预后的预测。 T淋巴细胞、NK淋巴细胞和B淋巴细胞亚群的异常重新分布已被发现参与其他疾病的发病机制，但在危重疾病中报道的证据不太令人信服[2]。除了我们之前的论文中描述的结果之外，在细胞学分析之后 [3]，我们还研究了在我们的文章 [4] 中报告的 52 名感染性休克患者中结合不同的 T 细胞、B 细胞和 NK 细胞标记物的结果预测价值。
为每个表型变量建立接受者操作特征曲线。由此获得每个变量预测真实结果的敏感性和特异性[5]。选择并组合具有较高敏感度值的变量以创建多个变量组合或掩模。选择具有最高敏感性和特异性的掩模来预测这些患者的结果。
根据这种方法，我们发现了一组五个免疫表型变量（CD3+CD8+CD28+、CD3+-CD8+CD45RA+CD45RO-、CD19+CD80+、CD56+CD69+、CD3+CD11A br+CD11B+）及其截止值（分别为 163、114、67、114、250 个淋巴细胞/μl）能够将感染性休克患者的结果预测提高到 94% 的敏感性和 100% 的特异性。因此，我们得出结论，外周血单核细胞的免疫表型研究有助于预测脓毒性休克患者的结果。
In agreement with McDunn and Hotchkiss [1], we hypothesized that the simultaneous analysis of different immune system cell subsets would improve the prediction of outcome in septic shock patients. Abnormal redistribution of T-lymphocyte, NK-lymphocyte and B-lymphocyte subsets has been found to be involved in the pathogenesis of other diseases, but the evidence reported in critical illness is less compelling [2]. In addition to the results described in our previous paper, and following a cytomic analysis [3], we have also studied the predicting value for outcome of combining different T-cell, B-cell and NK-cell markers in the 52 septic shock patients reported in our article [4].
Receiver operating characteristic curves were built for each phenotypic variable. The sensitivity and specificity of each variable to predict the real outcome was thus obtained [5]. The variables with higher sensitivity values were selected and combined to create multiple variable combinations or masks. The mask with the highest sensitivity and specificity was selected to predict the outcome of these patients.
According to this methodology we have found a set of five immunophenotypic variables (CD3+CD8+CD28+, CD3+-CD8+CD45RA+CD45RO-, CD19+CD80+, CD56+CD69+, CD3+CD11A br+CD11B+) and their cutoff values (163, 114, 67, 114, 250 lymphocytes/μl, respectively) that are able to improve the prediction for outcome in septic shock patients to a sensitivity of 94% and a specificity of 100%. We therefore conclude that the immunophenotypic study of peripheral blood mononuclear cells is useful to predict the outcome of septic shock patients.