免疫状态与呼吸机相关性肺炎的相关性研究  

Study on correlation of immune status with occurrence of ventilator-associated pneumonia

作　　者：李学莉[1] 郭旻[1] 沙玉霞[1] 马希刚[2] 曹相原[2] 

机构地区：[1]银川市第一人民医院ICU,宁夏银川750001 [2]宁夏医科大学总院ICU,宁夏银川750004

出　　处：《中华医院感染学杂志》2011年第24期5171-5173,共3页Chinese Journal of Nosocomiology

基　　金：宁夏回族自治区卫生厅项目(2009044)

摘　　要：目的研究免疫状态在呼吸机相关性肺炎(VAP)发生机制中的作用。方法对58例无肺部感染行机械通气的患者入科时、48h和1周行血清瘦素、CD4+及CD8+T细胞、淋巴细胞计数的检测,并对患者行临床肺部感染评分(CPIS)和序贯器官衰竭(SOFA)评分。结果 58例患者中发生VAP 23例,为VAP组,非VAP患者35例,为NVAP组;两组患者在入科时血清瘦素水平差异无统计学意义,其中,VAP组患者血清瘦素水平在机械通气48h和1周分别为(3.735±0.445)、(3.727±0.393)pg/ml,NVAP组血清瘦素水平在机械通气48h和1周分别为(3.469±0.393)、(3.485±0.355)pg/ml,VAP组血清瘦素水平均高于NVAP组(P<0.05);VAP组CD8+T细胞在机械通气1周时为(27.00±5.92)%,NVAP组CD8+T细胞在机械通气1周时为(23.89±5.45)%,VAP组CD8+T细胞在机械通气1周时高于NVAP组(P<0.05);VAP组患者淋巴细胞计数在1周时低于NVAP组(P<0.05);VAP组CPIS评分和SOFA评分在1周时高于NVAP组(P<0.05)。结论血清瘦素水平升高易发生VAP;其机制可能与其介导细胞免疫低下有关。OBJECTIVE To study the mechanism of the immune status in the ventilator-associated pneumonia（VAP）. METHODS A total of 58 cases the patient of non-pulmonary infection were treated by mechanical ventilation when entered into the division,the indicators of serum leptin,CD4＋,CD8＋ T cells and lymphocyte count were tested when enter into the division,48 h,and 1week,meanwhile,the score of CPIS and the SOFA were acquired at same time. RESULTS Though analyzing above indicators,23 cases were suffered thewere acquired at same time. RESULTS Though analyzing above indicators, 23 cases were suffered the VAP （VAP group） , the levels of serum leptin of the two groups was no difference when they entered into the warde, which, the levels of serum leptin of VAP group were （3. 735±0. 445） and （3. 727±0. 393 ）pg/ml after mechanical ventilation treatment at 48h and I week, the levels of serum leptin of NVAP group were （3. 469±0. 393） and （3. 4854±0. 355） pg/ml after mechanical ventilation treatment at 48 h and 1 week, the levels of serum leptin of VAP group was higher than the NVAP group （P〈0.05） ;CD8 ＋ T cells of VAP group was （27.00±5.92） （%） after mechanical ventilation treatment at the first week, CD8 ＋ T cells of NVAP group was 23.89 ±5.45 （%） after mechanical venulauon treatment at the first week, CD6 ＋ T cells of VAP group was higher than the NVAP group after mechanical ventilation treatment at the first week （P〈0.05） ; the counts of Lymphocyte in VAP group was lower than NVAP group at the first week （P〈0.05） ; the scores of CPIS and SOFA in VAP group were higher than the NVAP group at 1week （P（0.05）. CONCLUSION The high level of serum leptin leads to VAP probably; the mechanism must be related to the immunosuppression through meaning of leptin.

关 键 词：呼吸机相关性肺炎 免疫 相关性 

分 类 号：R181.32[医药卫生—流行病学]