持续性炎症－免疫抑制－分解代谢综合征63例临床分析

丁仁彧; 邱佳男; 刘宝燕; 李晓霞; 孙旖旎; 梁英健; 肇冬梅; 朱然; 章志丹; 马晓春

doi:10.3760/cma.j.issn.0578-1426.2016.12.007

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ENGLISH ABSTRACT

持续性炎症－免疫抑制－分解代谢综合征63例临床分析

作者及单位信息

出版日期： 2016 -12 -01 ·

DOI： 10.3760/cma.j.issn.0578-1426.2016.12.007

A retrospective clinical study of sixty-three cases with persistent inflammation immunosuppression and catabolism syndrome

Authors Info & Affiliations

Ding Renyu

Department of Intensive Care Unit, the First Hospital of China Medical University, Shenyang 110001, China

Qiu Jianan

Liu Baoyan

Li Xiaoxia

Sun Yini

Liang Yingjian

Zhao Dongmei

Zhu Ran

Zhang Zhidan

Ma Xiaochun

Published： 2016 -12 -01 ·

DOI： 10.3760/cma.j.issn.0578-1426.2016.12.007

2678

108

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摘要

目的通过分析入住ICU的持续性炎症－免疫抑制－分解代谢综合征(PICS)患者的临床特点及预后，提高对PICS的认识，以进一步明确PICS的临床意义。

方法回顾性分析2014年1月1日至12月31日入住中国医科大学附属第一医院重症医学科≥10 d、年龄≥18岁的126例患者的临床资料，包括性别、年龄、入ICU的急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官功能衰竭评分(SOFA)、入ICU诊断、实验室指标、ICU获得性感染、临床转归等。

结果126例患者中63例发生PICS，63例为非PICS患者，PICS发生率为50.0%。PICS组和非PICS组患者性别、年龄、基础疾病、入ICU时APACHEⅡ、SOFA、患者来源差异均无统计学意义( P>0.05)；两组患者内、外科疾病占比差异无统计学意义( P>0.05)；PICS组患者发生消化道穿孔比例较非PICS组高( P＝0.042)。PICS组继发ICU获得性感染比例高于非PICS组[63.5%(40/63)比23.8%(15/63)； P<0.001]；PICS组念珠菌占致病菌比例较非PICS组高[22.4%(11/49)比2/17； P＝0.003]。与非PICS组比，PICS组住ICU时间明显延长[(31.6±28.8) d比(20.4±11.3) d； P＝0.0046]，ICU病死率明显升高[28.6%(18/63)比6.3%(4/63)； P＝0.001]。

结论PICS在ICU患者中常见，PICS患者继发感染的风险高，住ICU时间长，ICU病死率高。

关键词：持续性炎症－免疫抑制－分解代谢综合征;免疫;感染;预后

ABSTRACT

ObjectiveTo study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome (PICS) in ICU.

MethodsA total of 126 patients admitted to ICU (ICU stay of more than 10 days, age≥18 years) between January 2014 to December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics, underlying disease, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment (SOFA) score, laboratory parameters, ICU acquired infections and clinical outcome.

ResultsThe overall incidence of PICS in ICU patients (ICU stay of more than 10 days) was 50.0%(63/126). There were no significant differences in baseline data such as gender, age, APACHEⅡscore, SOFA score and underlying diseases between the two groups(all P>0.05). Compared with the non-PICS group, there were more patients with gastrointestinal perforation in the PICS group ( P=0.042), however, the medical or surgical admission did not differ between the two groups( P>0.05). During the stay in ICU, the PICS group showed a higher risk of developing acquired infections compared with the non-PICS group[PICS 63.5%(40/63) vs non-PICS 23.8%(15/63); P<0.001]. The infections were more caused by Candida in the PICS group than the non-PICS group [PICS 22.4%(11/49) vs non-PICS 2/17; P=0.003]. Moreover, the PICS group experienced longer stay in ICU[PICS(31.6±28.8) days vs non-PICS (20.4±11.3) days; P=0.0046] and higher ICU mortality [PICS 28.6%(18/63) vs non-PICS 6.3%(4/63), P=0.001].

ConclusionPICS is a common manifestation of patients who stay in ICU more than 10 days, which is associated with high risk of ICU acquired infections, prolonged length of stay and high mortality.

KEYWORDS： Persistent inflammation immunosuppression and catabolism syndrome;Immunity;Infection;Prognosis

Corresponding author: Ma Xiaochun, Email: mocdef.aabnis2792amcx

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引用本文

丁仁彧,邱佳男,刘宝燕,等. 持续性炎症－免疫抑制－分解代谢综合征63例临床分析[J]. 中华内科杂志,2016,55(12)：941-944.

DOI:10.3760/cma.j.issn.0578-1426.2016.12.007

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随着重症医学诊疗水平的不断进步，越来越多的重症患者得以成功度过早期危重状态，暴发的全身炎症反应综合征(SIRS)及多器官功能障碍综合征(MODS)得到缓解，其中一部分患者由于仍残留器官功能障碍，而滞留于ICU，这些患者往往表现为迅速下降的体重或极差的营养状态、长期的免疫抑制及反复发生的院内感染。近年来有学者将具有上述特征的患者归类，并建立了持续性炎症－免疫抑制－分解代谢综合征(persistent inflammation immunosuppression catabolism syndrome，PICS)概念；这类患者同时面临着慢性炎症、获得性免疫抑制、继发院内感染和严重的蛋白分解代谢等，导致了医疗资源的消耗，也给家属及社会造成巨大的经济负担 ^{[
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参考文献

参考文献

[1]

Gentile LF , Cuenca AG , Efron PA ,et al. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care[J]. J Trauma Acute Care Surg, 2012,72(6):1491-1501. DOI: 10.1097/TA.0b013e318256e000 .

返回引文位置Google Scholar

百度学术

万方数据

[2]

Vanzant EL , Lopez CM , Ozrazgat－Baslanti T ,et al. Persistent inflammation, immunosuppression, and catabolism syndrome after severe blunt trauma[J]. J Trauma Acute Care Surg, 2014,76(1):21-29. DOI: 10.1097/TA.0b013e3182ab1ab5 .

返回引文位置Google Scholar

百度学术

万方数据

[3]

Hu D , Ren J , Wang G ,et al. Persistent inflammation－immunosuppression catabolism syndrome, a common manifestation of patients with enterocutaneous fistula in intensive care unit[J]. J Trauma Acute Care Surg, 2014,76(3):725-729. DOI: 10.1097/TA.0b013e3182aafe6b .

返回引文位置Google Scholar

百度学术

万方数据

[4]

马晓春，陈铭铭. 持续性炎症－免疫抑制分解代谢综合征－ICU滞留患者炎症、免疫及代谢状态新解说[J]. 中国危重病急救医学， 2012，24(9)：514-516. DOI： 10.3760/cma.j.issn.1003-0603.2012.09.002 .

返回引文位置Google Scholar

百度学术

万方数据

[5]

Hotchkiss RS , Opal S . Immunotherapy for sepsis－a new approach against an ancient foe[J]. N Engl J Med, 2010,363(1):87-89. DOI: 10.1056/NEJMcibr1004371 .

返回引文位置Google Scholar

百度学术

万方数据

[6]

陈辉，杨毅. 持续性炎症－免疫抑制－分解代谢综合征：重症感染的真凶？[J]. 中华内科杂志， 2015，54(8)：670-671. DOI： 10.3760/cma.j.issn.0578-1426.2015.08.003 .

返回引文位置Google Scholar

百度学术

万方数据

[7]

Rosenthal MD , Moore FA . Persistent inflammatory, immunosuppressed, catabolic syndrome (PICS): a new phenotype of multiple organ failure[J]. J Adv Nutr Hum Metab, 2015,1(1):pii:e784. DOI: 10.14800/janhm.784 .

返回引文位置Google Scholar

百度学术

万方数据

[8]

Angus DC , van der Poll T . Severe sepsis and septic shock[J]. N Engl J Med, 2013,369(9):840-851. DOI: 10.1056/NEJMra1208623 .

返回引文位置Google Scholar

百度学术

万方数据

[9]

Wu JF , Ma J , Chen J ,et al. Changes of monocyte human leukocyte antigen－DR expression as a reliable predictor of mortality in severe sepsis[J]. Crit Care, 2011,15(5):R220. DOI: 10.1186/cc10457 .

返回引文位置Google Scholar

百度学术

万方数据

[10]

Huang X , Venet F , Wang YL ,et al. PD－1 expression by macrophages plays a pathologic role in altering microbial clearance and the innate inflammatory response to sepsis[J]. Proc Natl Acad Sci U S A, 2009,106(15):6303-6308. DOI: 10.1073/pnas.0809422106 .

返回引文位置Google Scholar

百度学术

万方数据

[11]

Kullberg BJ , van de Veerdonk F , Netea MG . Immunotherapy: a potential adjunctive treatment for fungal infection[J]. Curr Opin Infect Dis, 2014,27(6):511-516. DOI: 10.1097/QCO.0000000000000105 .

返回引文位置Google Scholar

百度学术

万方数据

[12]

Ravikumar S , Win MS , Chai LY . Optimizing outcomes in immunocompromised hosts: understanding the role of immunotherapy in invasive fungal diseases[J]. Front Microbiol, 2015,6:1322. DOI: 10.3389/fmicb.2015.01322 .

返回引文位置Google Scholar

百度学术

万方数据

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通信作者：马晓春，Email： mocdef.aabnis2792amcx

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