Abstract: Objective　To investigate the characteristics of immune status in patients with sepsis complicated by different stages of metabolic syndrome（MS），and their effects on prognosis.Methods　A total of 200 patients with sepsis who were hospitalized in the Department of Emergency ，the Second Affiliated Hospital of Hainan Medical University between January 2014 and June 2017 were prospectively selected and divided into the following four groups according to the presence of MS complication and MS status：MS systemic inflammatory syndrome group（MSS group，50 cases），MS severe sepsis group（MSSS group，50 cases），non-MS systemic inflammatory syndrome group（NMSS group，50 cases） and non-MS severe sepsis group（NMSSS group，50 cases）．A control group included 50 persons who received a health examination in our hospital.Patients with sepsis were also divided into a survival subgroup and a death subgroup.The peripheral blood T-lymphocyte-related immunological indicators（CD3+T，CD4+T，CD8+T，CD4+T/CD8+T） in each group were tested and compared.Results　The Acute Physiology and Chronic Health Evaluation systemⅡ（APACHE Ⅱ） and sequential organ failure assessment（SOFA） scores in the MSSS group were higher than those in the MSS group（P<0.05），and the APACHE Ⅱand SOFA scores in the NMSSS group were higher than those in the NMSS group（P<0.05）．The SOFA score in the MSSS group was higher than that in the NMSSS group（P<0.05）．The percentages of T lymphocytes in the sepsis groups were all lower than that in the control group（P<0.05）．The levels of CD+3T，CD+4T and CD+8T cells were lower in the MSSS group and NMSSS group than the MSS group （P<0.05），and lower in the MSSS group than the NMSSS group（P<0.05）．The MSSS and NMSSS groups had higher mortality than did the MSS and NMSS groups（P<0.05），and the mortality in the MSSS group was higher than that in the NMSSS group （P<0.05）．The APACHE Ⅱ and SOFA scores，and the incidence of MS in the death subgroup were all higher than those in the survival subgroup，and the levels of CD+3T，CD+4T，CD+8T and CD+4T/CD+8 T were lower in the death subgroup than the survival subgroup（P<0.05）．Conclusion　MS aggravates immunosuppression and disease severity in patients with sepsis and affects their prognosis.

Key words: Sepsis, Systemic inflammatory response syndrome, Metabolic syndrome X, T-lymphocytes, Prognosis

摘要： 目的　探讨脓毒症合并代谢综合征（MS）患者在脓毒症不同分期时免疫状态的变化特点及其对预后的影响。方法　前瞻性选取2014年1月—2017年6月在海南医学院第二附属医院急诊科住院治疗的脓毒症患者200例为研究对象，根据是否合并MS和脓毒症状态分成MS全身炎症反应综合征组（MSS组，50例）、MS严重脓毒症组（MSSS组，50例）、非MS的全身炎症反应综合征组（NMSS组，50例）、非MS严重脓毒症组（NMSSS组，50例），另选取50例本院健康体检者作为对照组。再根据预后将脓毒症患者分为存活亚组和死亡亚组。分别检测各组外周血T淋巴细胞相关免疫指标〔包括CD3阳性T淋巴细胞（CD3+T淋巴细胞）、CD4阳性T淋巴细胞（CD4+T淋巴细胞）、CD8阳性T淋巴细胞（CD8+T淋巴细胞）及CD4+T淋巴细胞/CD8+T淋巴细胞〕并进行比较。结果　MSSS组急性生理学及慢性健康状况评分系统Ⅱ（APACHE Ⅱ）、感染相关器官功能衰竭评分系统（SOFA）评分高于MSS组，NMSSS组高于NMSS组（P<0.05）；MSSS组SOFA评分高于NMSSS组（P<0.05）。4组脓毒症患者CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞均低于对照组（P<0.05）。MSSS组和NMSSS组患者CD+3T、CD+4T及CD+8T低于MSS组（P<0.05），MSSS组低于NMSSS组（P<0.05）。MSSS组与NMSSS组28 d病死率高于MSS组与NMSS组（P<0.05），MSSS组28 d病死率高于NMSSS组（P<0.05）。死亡亚组APACHE Ⅱ评分、SOFA评分及MS发生率高于存活亚组，CD+3T、CD+4T、CD+8T及CD+4T/CD+8T低于存活亚组（P<0.05）。结论　MS可加重脓毒症患者细胞免疫抑制及病情，从而影响其预后。

关键词: 脓毒症, 全身炎症反应综合征, 代谢综合征X, T淋巴细胞, 预后