中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
2期
100-102
,共3页
孙成栋%刘斯%李真%文艳
孫成棟%劉斯%李真%文豔
손성동%류사%리진%문염
重症肺炎%辅助性T细胞亚群%降钙素原
重癥肺炎%輔助性T細胞亞群%降鈣素原
중증폐염%보조성T세포아군%강개소원
Severe pneumonia%Subgroup of helper T lymphocyte%Calcitonin
目的 观察医院获得性肺炎(HAP)重症患者辅助性T细胞亚群变化以及血清降钙素原(PCT)水平,并观察其在不同病情程度患者中的变化以及二者之间的相关性.方法 选择符合HAP诊断的患者89例(重症59例,轻症30例),以20例健康成人为对照,测定外周血CD4阳性细胞中Th1、Th2细胞百分比和Th1/Th2比值,采用双夹心免疫发光法检测血清PCT水平.结果 重症肺炎组Th1细胞[(8.40±3.01)％]明显低于轻症肺炎组[(13.90±2.37)％,P＜0.05]和健康对照组[(17.40±4.20)％,P＜0.01];重症肺炎组Th2细胞[(17.30±5.74)％]则明显高于轻症肺炎组[(7.70±2.35)％,P＜0.05]和健康对照组[(7.90±1.92)％,P＜0.01];重症肺炎组Th1/Th2比值(0.57±0.15)也明显低于轻症肺炎组(2.80±0.46,P＜0.01)和健康对照组(3.11±0.87,P＜0.01).与健康对照组相比,轻症肺炎组Th1细胞明显降低(P＜0.05),但Th2细胞和Th1/Th2比值无明显差异(均P ＞0.05).重症肺炎、轻症肺炎及健康对照3组CD4阳性细胞无明显差异[分别为(30.20±10.83)％、(34.70±13.57)％、(28.80±9.61)％,均p＞0.05].与健康对照组比较,轻、重症肺炎组PCT( μg/L)均明显升高(1.73±0.88、3.51±2.66比0.30±0.10,均P＜0.01);且重症肺炎组PCT水平较轻症肺炎组明显升高(P＜0.05).Th1/Th2与PCT的回归分析显示,回归方程为Y=-0.937x,呈显著负相关(F=236.23,P=0.0000).结论 HAP重症患者存在明显的Th1/Th2细胞失衡、细胞免疫功能下降,Th2细胞和抗炎反应优势是导致感染加剧和多器官功能障碍综合征的主要原因;PCT与Th1/Th2呈明显负相关.PCT可作为检测机体免疫应答的一个指标,从侧面体现机体细胞免疫与体液免疫反应的程度.
目的 觀察醫院穫得性肺炎(HAP)重癥患者輔助性T細胞亞群變化以及血清降鈣素原(PCT)水平,併觀察其在不同病情程度患者中的變化以及二者之間的相關性.方法 選擇符閤HAP診斷的患者89例(重癥59例,輕癥30例),以20例健康成人為對照,測定外週血CD4暘性細胞中Th1、Th2細胞百分比和Th1/Th2比值,採用雙夾心免疫髮光法檢測血清PCT水平.結果 重癥肺炎組Th1細胞[(8.40±3.01)％]明顯低于輕癥肺炎組[(13.90±2.37)％,P＜0.05]和健康對照組[(17.40±4.20)％,P＜0.01];重癥肺炎組Th2細胞[(17.30±5.74)％]則明顯高于輕癥肺炎組[(7.70±2.35)％,P＜0.05]和健康對照組[(7.90±1.92)％,P＜0.01];重癥肺炎組Th1/Th2比值(0.57±0.15)也明顯低于輕癥肺炎組(2.80±0.46,P＜0.01)和健康對照組(3.11±0.87,P＜0.01).與健康對照組相比,輕癥肺炎組Th1細胞明顯降低(P＜0.05),但Th2細胞和Th1/Th2比值無明顯差異(均P ＞0.05).重癥肺炎、輕癥肺炎及健康對照3組CD4暘性細胞無明顯差異[分彆為(30.20±10.83)％、(34.70±13.57)％、(28.80±9.61)％,均p＞0.05].與健康對照組比較,輕、重癥肺炎組PCT( μg/L)均明顯升高(1.73±0.88、3.51±2.66比0.30±0.10,均P＜0.01);且重癥肺炎組PCT水平較輕癥肺炎組明顯升高(P＜0.05).Th1/Th2與PCT的迴歸分析顯示,迴歸方程為Y=-0.937x,呈顯著負相關(F=236.23,P=0.0000).結論 HAP重癥患者存在明顯的Th1/Th2細胞失衡、細胞免疫功能下降,Th2細胞和抗炎反應優勢是導緻感染加劇和多器官功能障礙綜閤徵的主要原因;PCT與Th1/Th2呈明顯負相關.PCT可作為檢測機體免疫應答的一箇指標,從側麵體現機體細胞免疫與體液免疫反應的程度.
목적 관찰의원획득성폐염(HAP)중증환자보조성T세포아군변화이급혈청강개소원(PCT)수평,병관찰기재불동병정정도환자중적변화이급이자지간적상관성.방법 선택부합HAP진단적환자89례(중증59례,경증30례),이20례건강성인위대조,측정외주혈CD4양성세포중Th1、Th2세포백분비화Th1/Th2비치,채용쌍협심면역발광법검측혈청PCT수평.결과 중증폐염조Th1세포[(8.40±3.01)％]명현저우경증폐염조[(13.90±2.37)％,P＜0.05]화건강대조조[(17.40±4.20)％,P＜0.01];중증폐염조Th2세포[(17.30±5.74)％]칙명현고우경증폐염조[(7.70±2.35)％,P＜0.05]화건강대조조[(7.90±1.92)％,P＜0.01];중증폐염조Th1/Th2비치(0.57±0.15)야명현저우경증폐염조(2.80±0.46,P＜0.01)화건강대조조(3.11±0.87,P＜0.01).여건강대조조상비,경증폐염조Th1세포명현강저(P＜0.05),단Th2세포화Th1/Th2비치무명현차이(균P ＞0.05).중증폐염、경증폐염급건강대조3조CD4양성세포무명현차이[분별위(30.20±10.83)％、(34.70±13.57)％、(28.80±9.61)％,균p＞0.05].여건강대조조비교,경、중증폐염조PCT( μg/L)균명현승고(1.73±0.88、3.51±2.66비0.30±0.10,균P＜0.01);차중증폐염조PCT수평교경증폐염조명현승고(P＜0.05).Th1/Th2여PCT적회귀분석현시,회귀방정위Y=-0.937x,정현저부상관(F=236.23,P=0.0000).결론 HAP중증환자존재명현적Th1/Th2세포실형、세포면역공능하강,Th2세포화항염반응우세시도치감염가극화다기관공능장애종합정적주요원인;PCT여Th1/Th2정명현부상관.PCT가작위검측궤체면역응답적일개지표,종측면체현궤체세포면역여체액면역반응적정도.
Objective To observe the changes in subgroups of helper T cells and serum calcitionin (PCT)levels in patients with hospital acquired pneumonia (HAP) and their correlation.Methods Eighty-nine patients with diagnosis of HAP (severe in 59 patients,mild in 30 cases) were included,with 20 healthy adults as control.Percentage of CD4+,Th1 and Th2 cells,and Th1/Th2 ratio were determined,and sandwich immune luminescence was used to detect the level of serum PCT.Results The percentage of Th1 cells [ (8.40 ± 3.01 )％ ] was significandy lower in patients with severe HAP compared with that of mild pneumonia group [( 13.90 ± 2.37)％,P＜0.05] and healthy controls [ (17.40 ± 4.20)％,P＜0.01 ].Percentage of Th2 cells was obviously higher in patients with severe HAP [ (17.30 ± 5.74)％ ] than mild pneumonia group [ (7.70 ± 2.35 )％,P＜0.05 ] and healthy controls [ (7.90 ± 1.92)％,P＜0.01 ].Th1/Th2 ratio was also obviously lower in severe pneumonia group (0.57 ± 0.15 ) than that of mild pneumonia group ( 2.80 ± 0.46,P＜0.01 ) and healthy controls (3.11 ± 0.87,P＜0.01 ).Compared with healthy controls,Th1 cells in mild pneumonia patients were reduced significantly (P＜0.05),but there was no significant difference in Th2 cells and Th1/Th2 ratio (both P＞0.05).There was no difference in CD4+ among severe,mild pneumonia and healthy controls [ (30.20 ± 10.83 )％,(34.70 ± 13.57)％,(28.80 ± 9.61 )％,respectively,all P ＞0.05 ].The level of PCT ( μg/L ) was significantly elevated in mild and severe pneumonia patients compared with that of healthy controls ( 1.73 ±0.88,3.51 ± 2.66 vs.0.30 ± 0.10,both P＜0.01 ),and the level of PCT in severe pneumonia was significandy higher than that of mild pneumonia (P＜0.05).Regression analysis of Th1/Th2 and PCT revealed a significant negative correlation,with regression equation Y =-0.937x (F=236.23,P=0.0000).Conclusions Patients with severe HAP had obvious imbalance of Th1/Th2.The suppression of cellular immune function,reduction in Th2 cells and exacerbation of anti-inflammatory reaction intensify the infection leading to multiple organ dysfunction syndrome.There is obvious negative correlation between Th1/Th2 and PCT.PCT could be used as an indicator of immune response in reflecting cellular and humoral immunity of the patient.
