T细胞亚群与临床肺部感染评分在老年院内获得性肺炎预后评价中的作用
T세포아군여림상폐부감염평분재노년원내획득성폐염예후평개중적작용
Evaluating prognosis of hospital-acquired pneumonia in elderly patients by using T cell subsets and clinical pulmonary infection score
  • 万方数据
    中华急诊医学杂志 중화급진의학잡지
    CHINESE JOURNAL OF EMERGENCY MEDICINE
    2014年 4期 377-381 ,共5页

    李莲花%杨倩%栾禹博%晁彦公%王仲

    리연화%양천%란우박%조언공%왕중

    院内获得性肺炎%T细胞亚群%临床肺部感染评分%预后 院內穫得性肺炎%T細胞亞群%臨床肺部感染評分%預後
    원내획득성폐염%T세포아군%림상폐부감염평분%예후
    Hospital acquired pneumonia%T cell subsets%Clinical pulmonary infection score%Prognosis
    目的 探讨T细胞亚群与临床肺部感染评分(clinical pulmonary infection score,CPIS)在院内获得性肺炎(hospital acquired pneumonia,HAP)预后评价中的作用.方法 采用前瞻性观察研究,病例组入选了北京华信医院重症监护病房(Intensive care unit,ICU)和急诊病房2012年8月至2013年7月收治的连续90例患者,所有患者均符合HAP诊断标准,根据患者预后分为存活组50例和死亡组40例,以同期入院的35位老年非感染患者为对照组;本研究病例组排除自身免疫性疾病、免疫缺陷病、超敏反应性疾病、肿瘤、糖尿病、创伤、手术相关性疾病和近期接受免疫抑制剂或环氧合酶抑制剂(如阿司匹林)治疗的患者.对照组排除肺炎和其他可以导致CPIS升高的疾病患者;所有患者均计算急性生理与慢性健康状况Ⅱ评分(APACHEII评分).病例组需测定入院第1天、起病后第1天及起病后第5天晨起空腹肘静脉血T细胞亚群,包括CD3、CD4+、CD8+、CD4 +/CD8+比值,对照组需测定入院第1天的T细胞亚群,记录病例组入院第1天、起病后第1天及起病后第5天的临床肺部感染评分;采用流式细胞仪全自动分析软件测定T淋巴细胞亚群;计量资料以均数±标准差((x)±s)表示.存活组与死亡组组间对比采用独立样本t检验,存活组与死亡组组内对比采用配对样本t检验.对存活组和死亡组的CD4 +/CD8+值和CPIS评分值行直线相关分析.结果 存活组与死亡组患者的基线资料(年龄、性别、住院时间、APACHEⅡ评分等)差异无统计学意义(P＞0.05).入院第1天存活组、死亡组和对照组的CD3、CD4+、CD4+/CD8+值进行比较,差异均无统计学意义(P＞0.05);存活组和死亡组起病后第1天均较入院第1天的上述参数显著下降(P＜0.05);存活组起病后第5天较起病后第1天的上述参数显著升高(P＜0.05);死亡组起病后第5天和起病后第1天的上述参数差异无统计学意义(P＞0.05).以上组间及组内对比结果显示CD8的差异均无统计学意义(P＞0.05).存活组和死亡组起病后第1天的CPIS评分值显著高于入院第1天(P＜0.01),存活组起病后第5天的CPIS评分值显著低于起病后第1天(P＜0.01),而死亡组起病后第1天与起病后第5天的CPIS评分值差异无统计学意义(P＞0.05).对起病后第1天和第5天CD4+/CD8+比值和CPIS评分值行直线相关分析后的结果显示,二者成明显负相关(起病后第1天存活组R=-0.740,P=0.004;死亡组R=-0.613,P=0.035;起病后第5天存活组R=-0.639,P=0.009;死亡组R=-0.686,P=0.021).结论 HAP患者可以出现免疫失衡,表现为CD3+、CD4+、CD4+/CD8+比值的下降,且和疾病严重程度存在一定的相关性,据此可进行预后评价;CD4 +/CD8+比值与CPIS值呈明显负相关,动态监测T细胞亚群和CPIS对于评价老年HAP预后可能具有极为重要的临床指导意义.
    목적 탐토T세포아군여림상폐부감염평분(clinical pulmonary infection score,CPIS)재원내획득성폐염(hospital acquired pneumonia,HAP)예후평개중적작용.방법 채용전첨성관찰연구,병례조입선료북경화신의원중증감호병방(Intensive care unit,ICU)화급진병방2012년8월지2013년7월수치적련속90례환자,소유환자균부합HAP진단표준,근거환자예후분위존활조50례화사망조40례,이동기입원적35위노년비감염환자위대조조;본연구병례조배제자신면역성질병、면역결함병、초민반응성질병、종류、당뇨병、창상、수술상관성질병화근기접수면역억제제혹배양합매억제제(여아사필림)치료적환자.대조조배제폐염화기타가이도치CPIS승고적질병환자;소유환자균계산급성생리여만성건강상황Ⅱ평분(APACHEII평분).병례조수측정입원제1천、기병후제1천급기병후제5천신기공복주정맥혈T세포아군,포괄CD3、CD4+、CD8+、CD4 +/CD8+비치,대조조수측정입원제1천적T세포아군,기록병례조입원제1천、기병후제1천급기병후제5천적림상폐부감염평분;채용류식세포의전자동분석연건측정T림파세포아군;계량자료이균수±표준차((x)±s)표시.존활조여사망조조간대비채용독립양본t검험,존활조여사망조조내대비채용배대양본t검험.대존활조화사망조적CD4 +/CD8+치화CPIS평분치행직선상관분석.결과 존활조여사망조환자적기선자료(년령、성별、주원시간、APACHEⅡ평분등)차이무통계학의의(P＞0.05).입원제1천존활조、사망조화대조조적CD3、CD4+、CD4+/CD8+치진행비교,차이균무통계학의의(P＞0.05);존활조화사망조기병후제1천균교입원제1천적상술삼수현저하강(P＜0.05);존활조기병후제5천교기병후제1천적상술삼수현저승고(P＜0.05);사망조기병후제5천화기병후제1천적상술삼수차이무통계학의의(P＞0.05).이상조간급조내대비결과현시CD8적차이균무통계학의의(P＞0.05).존활조화사망조기병후제1천적CPIS평분치현저고우입원제1천(P＜0.01),존활조기병후제5천적CPIS평분치현저저우기병후제1천(P＜0.01),이사망조기병후제1천여기병후제5천적CPIS평분치차이무통계학의의(P＞0.05).대기병후제1천화제5천CD4+/CD8+비치화CPIS평분치행직선상관분석후적결과현시,이자성명현부상관(기병후제1천존활조R=-0.740,P=0.004;사망조R=-0.613,P=0.035;기병후제5천존활조R=-0.639,P=0.009;사망조R=-0.686,P=0.021).결론 HAP환자가이출현면역실형,표현위CD3+、CD4+、CD4+/CD8+비치적하강,차화질병엄중정도존재일정적상관성,거차가진행예후평개;CD4 +/CD8+비치여CPIS치정명현부상관,동태감측T세포아군화CPIS대우평개노년HAP예후가능구유겁위중요적림상지도의의.
    Objective To explore the prognosis of elderly patients suffered from hospital-acquired pneumonia (HAP) by T cell subsets and clinical pulmonary infection score (CPIS).Methods A cohort of 125 elderly patients admitted in ICU & ED (Emergency Department) from Aug,2012 to Jul,2013 were enrolled for a prospective and observational study.The patients were divided into 3 groups:HAP survival group (n =50,group A),HAP death group (n =40,group B) and non-HAP group (n =35,control group).The criteria of exclusion were patients with auto-immune diseases,immunodeficiency,allergic disorders,malignancies,diabetes,trauma,surgical diseases,or patients with recent use of immunosuppressive agents or cyclooxygenase-inhibitors (Aspirin etc.).In the control group,patients with nosocomial pneumonia and other diseases afecting the CPIS were excluded.APACHE Ⅱ scores of all patients were recorded.Blood T cell subsets (including values of CD3,CD4 +,CD8 +,and CD4 +/CD8 +)were measured on the admission day,the 1st day of HAP onset and the 5th day after onset of HAP in HAP patients whereas these measurements were tested only on the admission day in controls.Meanwhile,the CPISs were recorded on the admission day,the 1st day of HAP onset and the 5th day after onset of HAP in HAP patients.Flow cytometer (FCM) was used to detect T cell subsets.Data of statistical analysis were represented as Mean ± SD.The significant differences in T cell subsets and CPIS between survival group and death group were analyzed by independent t test.The paired samples t test was employed in survival group and death group.Linear correlation analysis was made between CD4 +/CD8 + ratio and CPIS in survival and death groups,respectively.Results There were no significant differences in demographics and clinical features (including age,sex,length of stay,APACHE Ⅱ scores) of patients in survivors and non-survivors (P ＞ 0.05).The values of CDs (CD3,CD4 + and CD4 +/CD8 + ratio) between patients of control group and patients of HAP groups were not significantly different on the admission day (P ＞ 0.05).The values of CDs on the admission day were much lower than those on the 1 st day of HAP onset in both survivors and nonsurvivors (P ＜ 0.05).The values of CDs on the 5th day after onset of HAP were higher than those on the 1 st day of HAP onset in the survival group (P ＜ 0.05),while there were no significant differences in CDs between different intervals after HAP onset in the death group (P ＞ 0.05).There were no significant changes in values of CD8 + in any group (P ＞ 0.05).Both survivors and non-survivors had much higher CPIS values on the 1st day of HAP onset than those on the admission day (P ＜0.01).The survival group had higher CPIS on the 5th day after onset of HAP compared to the 1st day of HAP onset (P ＜0.01),while there was no significant change in the death group.Linear correlation analysis showed negative correlation between CD4 +/CD8 + ratio and CPIS on both the 1 st day of HAP onset (survival group:R =-0.740,P =0.004 ; death group:R =-0.613,P =0.035) and the 5th day after onset of HAP (survival group:R =-0.639,P =0.009; death group:R=-0.686,P=0.021).Conclusions The hospital-acquired pneumonia appears as an immune imbalance disorder.The difference in CDs is a promising objective tool,aiding in prediction of prognosis of HAP in the elderly,the lower the CDs,the higher severity.The CD4 + / CD8 + ratio showed a negative correlation with CPIS.Monitoring of T cell subsets and CPIS may provide clinical value for the treatment of hospital-acquired pneumonia in the elderly.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문