CAJ | 학술논문

目的探讨长期卧床高龄患者医院内感染前后血浆白蛋白（ALB）水平及细胞免疫功能的变化及关系。方法选择2009年1月至2012年12月在广州军区广州总医院住院的长期卧床且住院期间发生院内感染的高龄患者共78例，按感染前、感染持续≥5d、感染持续≥10d以及感染进一步发展成严重脓毒症或脓毒性休克4个时期分为B组（n＝78）、C组（n＝52）、D组（n＝33）、E组（n＝25）；随机选择同期住院非长期卧床、无感染的高龄患者作为对照组（A组， n＝40）。分别检测不同时期患者血浆ALB水平、细胞免疫功能[包括外周血单核细胞表面人白细胞抗原-DR（HLA-DR）及T细胞亚群]；统计处理时进一步将感染前患者（B组）按血浆ALB水平分为ALB正常组（B1组，n＝16）和ALB偏低组（B2组，n＝62）。结果与A组相比，B组血浆ALB显著降低（P＝0.000）；与A组及B组相比，C、D、E三组血浆ALB均显著降低（P＝0.000）。与A组相比，B1组细胞免疫功能差异无统计学意义（P＞0.05），B2组HLA-DR的表达、CD3+T细胞绝对值以及CD4/CD8比值均显著降低（P＝0.000），CD8+T细胞占CD3+T细胞的百分数（CD8/CD3）显著升高（P＝0.000），CD4+T细胞占CD3+T细胞的百分数（CD4/CD3）差异无统计学意义（P＞0.05）。与A组及B组相比， C、D、E三组HLA-DR的表达、CD3+T细胞的绝对值、CD4/CD3以及CD4/CD8比值均显著减低（P＝0.000），CD8/CD3显著升高（P＝0.000）；而且HLA-DR、CD3+T细胞绝对值、CD4/CD3、CD8/CD3、CD4/CD8比值与血浆ALB水平的相关系数分别为r1＝0.791，r2＝0.638，r3＝0.534，r4＝-0.575，r5＝0.580（均P＝0.000）。结论长期卧床高龄患者医院内感染前血浆ALB已显著减低，感染后血浆ALB水平进一步下降，血浆ALB水平降低的患者其细胞免疫功能也下降，而且患者感染前后细胞免疫功能的下降与血浆ALB水平的降低密切相关。目的探討長期臥床高齡患者醫院內感染前後血漿白蛋白（ALB）水平及細胞免疫功能的變化及關繫。方法選擇2009年1月至2012年12月在廣州軍區廣州總醫院住院的長期臥床且住院期間髮生院內感染的高齡患者共78例，按感染前、感染持續≥5d、感染持續≥10d以及感染進一步髮展成嚴重膿毒癥或膿毒性休剋4箇時期分為B組（n＝78）、C組（n＝52）、D組（n＝33）、E組（n＝25）；隨機選擇同期住院非長期臥床、無感染的高齡患者作為對照組（A組， n＝40）。分彆檢測不同時期患者血漿ALB水平、細胞免疫功能[包括外週血單覈細胞錶麵人白細胞抗原-DR（HLA-DR）及T細胞亞群]；統計處理時進一步將感染前患者（B組）按血漿ALB水平分為ALB正常組（B1組，n＝16）和ALB偏低組（B2組，n＝62）。結果與A組相比，B組血漿ALB顯著降低（P＝0.000）；與A組及B組相比，C、D、E三組血漿ALB均顯著降低（P＝0.000）。與A組相比，B1組細胞免疫功能差異無統計學意義（P＞0.05），B2組HLA-DR的錶達、CD3+T細胞絕對值以及CD4/CD8比值均顯著降低（P＝0.000），CD8+T細胞佔CD3+T細胞的百分數（CD8/CD3）顯著升高（P＝0.000），CD4+T細胞佔CD3+T細胞的百分數（CD4/CD3）差異無統計學意義（P＞0.05）。與A組及B組相比， C、D、E三組HLA-DR的錶達、CD3+T細胞的絕對值、CD4/CD3以及CD4/CD8比值均顯著減低（P＝0.000），CD8/CD3顯著升高（P＝0.000）；而且HLA-DR、CD3+T細胞絕對值、CD4/CD3、CD8/CD3、CD4/CD8比值與血漿ALB水平的相關繫數分彆為r1＝0.791，r2＝0.638，r3＝0.534，r4＝-0.575，r5＝0.580（均P＝0.000）。結論長期臥床高齡患者醫院內感染前血漿ALB已顯著減低，感染後血漿ALB水平進一步下降，血漿ALB水平降低的患者其細胞免疫功能也下降，而且患者感染前後細胞免疫功能的下降與血漿ALB水平的降低密切相關。
목적탐토장기와상고령환자의원내감염전후혈장백단백（ALB）수평급세포면역공능적변화급관계。방법선택2009년1월지2012년12월재엄주군구엄주총의원주원적장기와상차주원기간발생원내감염적고령환자공78례，안감염전、감염지속≥5d、감염지속≥10d이급감염진일보발전성엄중농독증혹농독성휴극4개시기분위B조（n＝78）、C조（n＝52）、D조（n＝33）、E조（n＝25）；수궤선택동기주원비장기와상、무감염적고령환자작위대조조（A조， n＝40）。분별검측불동시기환자혈장ALB수평、세포면역공능[포괄외주혈단핵세포표면인백세포항원-DR（HLA-DR）급T세포아군]；통계처리시진일보장감염전환자（B조）안혈장ALB수평분위ALB정상조（B1조，n＝16）화ALB편저조（B2조，n＝62）。결과여A조상비，B조혈장ALB현저강저（P＝0.000）；여A조급B조상비，C、D、E삼조혈장ALB균현저강저（P＝0.000）。여A조상비，B1조세포면역공능차이무통계학의의（P＞0.05），B2조HLA-DR적표체、CD3+T세포절대치이급CD4/CD8비치균현저강저（P＝0.000），CD8+T세포점CD3+T세포적백분수（CD8/CD3）현저승고（P＝0.000），CD4+T세포점CD3+T세포적백분수（CD4/CD3）차이무통계학의의（P＞0.05）。여A조급B조상비， C、D、E삼조HLA-DR적표체、CD3+T세포적절대치、CD4/CD3이급CD4/CD8비치균현저감저（P＝0.000），CD8/CD3현저승고（P＝0.000）；이차HLA-DR、CD3+T세포절대치、CD4/CD3、CD8/CD3、CD4/CD8비치여혈장ALB수평적상관계수분별위r1＝0.791，r2＝0.638，r3＝0.534，r4＝-0.575，r5＝0.580（균P＝0.000）。결론장기와상고령환자의원내감염전혈장ALB이현저감저，감염후혈장ALB수평진일보하강，혈장ALB수평강저적환자기세포면역공능야하강，이차환자감염전후세포면역공능적하강여혈장ALB수평적강저밀절상관。
Objective To investigate the changes of plasma albumin (ALB) level and cellular immune function, and their relationship in elderly bed-ridden patients before and after nosocomial infection. Methods Seventy-eight elderly bed-ridden patients getting nosocomial infection during hospitalization in our department from January 2009 to December 2012 were enrolled in this study. The clinical data of the patients before getting nosocomial infection (group B, n=78), suffering from infection for ≥5d (group C, n=52) and for ≥10d (group D, n=33), and having severe sepsis/septic shock (group E, n=25) were collected and retrospectively analyzed. Another 40 elderly patients hospitalized in the same period without bed-ridden or infection served as control (group A). Plasma ALB level and cellular immune function, including peripheral blood mononuclear cell surface human leukocyte antigen-DR (HLA-DR) and T cell subsets, were compared among the patients at different periods. The group B were further assigned into group B1 (normal ALB level, n=16) and group B2 (lower ALB level, n=62) according to their ALB level. Results Plasma ALB level was significantly lower in group B than in group A (P=0.000), and significantly lower in group C, D, and E than in group A and B (P=0.000). Cellular immune function was similar in group B1 and group A. Patients of group B2 had significantly lower expression of HLA-DR, decreased absolute number of CD3+T cells and CD4/CD8 ratio (P=0.000), significantly increased percentage of CD8+T cells among CD3+T cells (CD8/CD3; P=0.000), and unchanged percentage of CD4+T cells among CD3+T cells(CD4/CD3; P>0.05). Compared with those of group A and B, HLA-DR expression, absolute number of CD3+ T cells, CD4/CD8 ratio, and CD4/CD3 ratio were significantly lower in group C, D and E (P=0.000), and CD8/CD3 was significantly higher (P=0.000). The changes of HLA-DR, absolute number of CD3+T cells, and CD4/CD3, CD8/CD3 and CD4/CD8 ratios were all correlated with plasma ALB level (r1=0.791, r2=0.638, r3=0.534, r4=-0.575, r5=0.580; P=0.000). Conclusion Plasma ALB level has been significantly reduced in elderly bed-ridden patients before nosocomial infection, and the level declines steadily thereafter the infection. The decreased cellular immune function before and after nosocomial infection is closely associated with the declined plasma ALB levels.