中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2013年
8期
1615-1618
,共4页
呼吸机相关性肺炎%T淋巴细胞亚群%免疫球蛋白%肺部感染
呼吸機相關性肺炎%T淋巴細胞亞群%免疫毬蛋白%肺部感染
호흡궤상관성폐염%T림파세포아군%면역구단백%폐부감염
Ventilator-associated pneumonia%T-Lymphocyte%Subsets Immunoglobulin%Pulmonary infection
目的 探讨免疫功能及免疫调理对呼吸机相关性肺炎(VAP)患者治疗反应及预后的评价.方法 对2011年1月至2012年3月入住内科重症监护病房(MICU)且资料完整的40例VAP,按治疗28 d转归分为存活组(24例)和死亡组(16例)；并进行临床肺部感染评分(GPIS).于确诊后第1天清晨留取外周静脉血,分别送检T淋巴细胞计数及免疫球蛋白检测.T淋巴细胞(CD3+)、辅助性T淋巴细胞(CD4+)、抑制性T淋巴细胞(CD8+)计数采用流式细胞仪检测、免疫球蛋白IgA、IgM、IgG采用免疫散射比浊法检测.同期选取20名健康人作为健康对照组.对其中30例VAP患者随机分为乌司他丁治疗组15例,对照组15例,于治疗前和治疗第7天留取外周血,分别送检T淋巴细胞计数及免疫球蛋白检测.结果 (1)死亡组外周血CD3+、CD4+、CD8+细胞计数、CD4 +/CD8+比值[(280.32±169.58)×106/L、(212.56±122.99)×106/L、(132.73±56.74)×106/L、1.48 ±0.82]和存活组外周血CD3+、CD4+、CD8+细胞计数、CD4+/CD8+比值[(485.05±209.18)× 106/L、(352.05±116.41)×106/L、(245.68±68.69)×106/L、2.02±1.06]均低于健康对照组[(1183±639.18)×106/L、(631±321.64)×106/L、(525±221.67)×106/L、2.78±1.04],差异有统计学意义(P＜0.05)；死亡组以上指标也明显低于存活组,差异有统计学意义(P＜0.05)；(2)死亡组患者血清免疫球蛋白IgG[(10.76±4.52) g/L]明显低于存活组[(13.65±6.34) g/L]及健康对照组[(14.39 ±7.47) g/L],差异有统计学意义(P＜0.05)；(3)30例VAP患者给予免疫干预后,治疗组外周血CD3+、CD4+细胞计数[(676.26±220.78)×106/L、(358.87±133.53)×106/L]明显高于治疗前水平[(429.28±130.46)×106/L、(216.85±106.32)×106/L],也明显高于对照组[(451.32±150.78)×106/L、(278.74 ±75.57)×106/L,P＜0.05].(4) CPIS评分与外周血CD3+、CD4+细胞计数呈负相关(r=-0.689、-0.594,P＜0.01).结论 VAP患者存在细胞免疫功能及体液免疫功能低下,给予乌司他J免疫治疗后,细胞免疫功能增强；CPIS评分与细胞免疫呈负相关,免疫功能监测可预测VAP患者的病情程度、治疗效果及预后.
目的 探討免疫功能及免疫調理對呼吸機相關性肺炎(VAP)患者治療反應及預後的評價.方法 對2011年1月至2012年3月入住內科重癥鑑護病房(MICU)且資料完整的40例VAP,按治療28 d轉歸分為存活組(24例)和死亡組(16例)；併進行臨床肺部感染評分(GPIS).于確診後第1天清晨留取外週靜脈血,分彆送檢T淋巴細胞計數及免疫毬蛋白檢測.T淋巴細胞(CD3+)、輔助性T淋巴細胞(CD4+)、抑製性T淋巴細胞(CD8+)計數採用流式細胞儀檢測、免疫毬蛋白IgA、IgM、IgG採用免疫散射比濁法檢測.同期選取20名健康人作為健康對照組.對其中30例VAP患者隨機分為烏司他丁治療組15例,對照組15例,于治療前和治療第7天留取外週血,分彆送檢T淋巴細胞計數及免疫毬蛋白檢測.結果 (1)死亡組外週血CD3+、CD4+、CD8+細胞計數、CD4 +/CD8+比值[(280.32±169.58)×106/L、(212.56±122.99)×106/L、(132.73±56.74)×106/L、1.48 ±0.82]和存活組外週血CD3+、CD4+、CD8+細胞計數、CD4+/CD8+比值[(485.05±209.18)× 106/L、(352.05±116.41)×106/L、(245.68±68.69)×106/L、2.02±1.06]均低于健康對照組[(1183±639.18)×106/L、(631±321.64)×106/L、(525±221.67)×106/L、2.78±1.04],差異有統計學意義(P＜0.05)；死亡組以上指標也明顯低于存活組,差異有統計學意義(P＜0.05)；(2)死亡組患者血清免疫毬蛋白IgG[(10.76±4.52) g/L]明顯低于存活組[(13.65±6.34) g/L]及健康對照組[(14.39 ±7.47) g/L],差異有統計學意義(P＜0.05)；(3)30例VAP患者給予免疫榦預後,治療組外週血CD3+、CD4+細胞計數[(676.26±220.78)×106/L、(358.87±133.53)×106/L]明顯高于治療前水平[(429.28±130.46)×106/L、(216.85±106.32)×106/L],也明顯高于對照組[(451.32±150.78)×106/L、(278.74 ±75.57)×106/L,P＜0.05].(4) CPIS評分與外週血CD3+、CD4+細胞計數呈負相關(r=-0.689、-0.594,P＜0.01).結論 VAP患者存在細胞免疫功能及體液免疫功能低下,給予烏司他J免疫治療後,細胞免疫功能增彊；CPIS評分與細胞免疫呈負相關,免疫功能鑑測可預測VAP患者的病情程度、治療效果及預後.
목적 탐토면역공능급면역조리대호흡궤상관성폐염(VAP)환자치료반응급예후적평개.방법 대2011년1월지2012년3월입주내과중증감호병방(MICU)차자료완정적40례VAP,안치료28 d전귀분위존활조(24례)화사망조(16례)；병진행림상폐부감염평분(GPIS).우학진후제1천청신류취외주정맥혈,분별송검T림파세포계수급면역구단백검측.T림파세포(CD3+)、보조성T림파세포(CD4+)、억제성T림파세포(CD8+)계수채용류식세포의검측、면역구단백IgA、IgM、IgG채용면역산사비탁법검측.동기선취20명건강인작위건강대조조.대기중30례VAP환자수궤분위오사타정치료조15례,대조조15례,우치료전화치료제7천류취외주혈,분별송검T림파세포계수급면역구단백검측.결과 (1)사망조외주혈CD3+、CD4+、CD8+세포계수、CD4 +/CD8+비치[(280.32±169.58)×106/L、(212.56±122.99)×106/L、(132.73±56.74)×106/L、1.48 ±0.82]화존활조외주혈CD3+、CD4+、CD8+세포계수、CD4+/CD8+비치[(485.05±209.18)× 106/L、(352.05±116.41)×106/L、(245.68±68.69)×106/L、2.02±1.06]균저우건강대조조[(1183±639.18)×106/L、(631±321.64)×106/L、(525±221.67)×106/L、2.78±1.04],차이유통계학의의(P＜0.05)；사망조이상지표야명현저우존활조,차이유통계학의의(P＜0.05)；(2)사망조환자혈청면역구단백IgG[(10.76±4.52) g/L]명현저우존활조[(13.65±6.34) g/L]급건강대조조[(14.39 ±7.47) g/L],차이유통계학의의(P＜0.05)；(3)30례VAP환자급여면역간예후,치료조외주혈CD3+、CD4+세포계수[(676.26±220.78)×106/L、(358.87±133.53)×106/L]명현고우치료전수평[(429.28±130.46)×106/L、(216.85±106.32)×106/L],야명현고우대조조[(451.32±150.78)×106/L、(278.74 ±75.57)×106/L,P＜0.05].(4) CPIS평분여외주혈CD3+、CD4+세포계수정부상관(r=-0.689、-0.594,P＜0.01).결론 VAP환자존재세포면역공능급체액면역공능저하,급여오사타J면역치료후,세포면역공능증강；CPIS평분여세포면역정부상관,면역공능감측가예측VAP환자적병정정도、치료효과급예후.
Objective To investigate the role of immune function and immunomodulation therapy and To evaluate the effect of immunomodulation therapy and prognosis in ventilator-associated pneumonia.Methods Choose ventilator-associated pneumonia (VAP) patients (complete cases) 40 cases from Jannural 2011 to March 2012 in intensive care unit (ICU) of Guiyang Medical University patients treated.and divided them into 2 groups according to the vesting:the survival group (24 cases)and the death group(16 cases).To evaluate the scores of clinical pulmonary infection score (CPIS) and immune function; Choose VAP patients (complete cases) 30 cases and randomly divided into ulinastatin treatment group (15 cases) and control group (15 cases),at onset of VAP and at 7days after onset to detect cytoactive of T-Lymphocyte Subsets with flow cytometry,and to detect.the serum level of IgA,IgM,IgG with immunol nephelometer.Choose 20 health people as heathy group.Results To compare p death group and survival group with heathy group,death of peripheral blood T lymphocytes CD3 +,CD4 +,CD8 + cell count,CD4+/CD8 +[(280.32 ± 169.58) × 106/L,(212.56 ± 122.99) × 106/L,(132.73 ± 56.74) × 106/L,1.48 ± 0.82]and the survival group [(485.05 ±209.18) × 106/L,(352.05 ± 116.41) × 106/L,(245.68 ±68.69) ×106/L,2.78 ± 1.04] was significantly lower than heathy group [(1183 ± 639.18) × 106/L,(631 ±321.64) × 106/L,(525 ± 221.67) × 106/L,2.78 ± 1.04],there was a significant difference(P ＜ 0.05).Death group of peripheral blood IgG [(10.76 ±4.52) g/L] was significantly lower than the survival group [(13.65 ± 6.34) g/L] and heathy group [(14.39 ± 7.47) g/L],there was a significant difference (P ＜0.05).Before treatment,there was no difference in all biomarkers between two group,after immunomodulation therapy,the therary group peripheral blood T lymphocytes CD3 +,CD4 + cell count was significantly higher than immunomodulation therapy before.The scores of CPIS for the two teams and CD3 +,CD4 + cell count all showed negative correlation (r =-0.689,-0.594,P ＜ 0.01).Conclusion VAP patients in intensive care unit have lower level of T-Lymphocyte Subsets,the immunomodulation therapy can improve immune function;The scores of CPIS and immune function showed negative correlation;Level of immune function can be used for patients to assess the severity of illness,to evaluate the effect of therapy and to prognosis of the important indices.
