T淋巴细胞亚群预测卒中相关性感染：前瞻性病例系列研究  

T-lymphocytes subsets predict stroke-associated infection： a prospective case series study

作　　者：马嘉[1] 闫福岭[2] 

机构地区：[1]东南大学附属中大医院康复科,南京210009 [2]东南大学附属中大医院神经内科,南京210009

出　　处：《国际脑血管病杂志》2012年第6期413-417,共5页International Journal of Cerebrovascular Diseases

基　　金：卫生部科研基金（LW201007）

摘　　要：目的探讨急性缺血性卒中患者T细胞亚群预测卒中相关性感染（stroke—associated infection，SAI）的价值。方法连续入组发病36h内的急性缺血性卒中患者，入院次日清晨采集外周静脉血，应用流式细胞仪进行T细胞亚群检测。根据住院2周内是否发生感染，将患者分为感染组和非感染组。收集缺血性卒中的危险因素资料，分析SAI与相关危险因素的关系。结果共纳入55例急性缺血性卒中患者，其中感染组28例，非感染组27例。感染组CD3^＋T细胞百分比[（63．42±8．84）％对（69．55±10．05）％；P=0．022]、CD4^＋T细胞百分比[（35．34±7．10）％对（40．46±7．24）％；P=0．014）和CD4^＋／CD8^＋比值（1．23±0．38对1．55±0．56；P=0．023）均显著低于非感染组。多变量logistic回归分析显示，NIHSS评分较高（优势比1．295，95％可信区间1．084～1．547；P=0．004）和CD4^＋T细胞百分比降低（优势比0．874，95％可信区间0．784～0．974；P=0．015）是SAI的独立预测因素。CD4^＋T细胞百分比〈70．35％对SAI的发生具有最佳的预测价值，敏感性为77．8％，特异性为92．3％。结论急性缺血性卒中发病后辅助性T细胞比例下降可增高SAI的易感性，T细胞亚群检测可在一定程度上预测SAI。Objective To investigate the value of T cell subsets predicting stroke-associated infection （SAI） in patients with acute ischemic stroke. Methods The consecutive patients with acute ischemic stroke within 36 hours after symptom onset were included. The peripheral venous blood samples were collected the next morning after admission. A flow cytometry was used to detect T cell subsets. The patients were divided into either an infected group or a non-infected group according to whether they had infection or not in hospital within 2 weeks. The information of the risk factors for ischemic stroke was collected, and the relationship between SAI and related risk factors was analyzed. Results A total of 55 patients with acute ischemic stroke were included, 28 of them were in the infected group and 27 were in the non-infected group. The percentages of CD3^＋T cells （63.42±8.84% vs. 69.55± 10.05%; P=0.022） and CD4^＋T cells （35.34±7.10% vs. 40. 46 ± 7. 24% ; P = 0. 014）, and CD4 ^＋/CD8 ^＋ ratio （1.23 ± 0. 38 vs. 1.55 ± 0. 56; P = 0. 023） in the infected group were Sigiificantly lower than those in the non-infected goup. The multiple regession analysis showed that the higher NIHSS score （odds ratio [ OR] 1. 295, 95% confidence interval [ CI] 1.084 - 1.574; P = 0. 004） and the decreased percentage of CD4 ^＋ T cells （OR 0. 874, 95% CI 0. 784 - 0. 974, P = 0. 015） were the independent predicting factors for SAI. The percentage of CD4 ^＋ T cells 〈 70. 35% had the best predictive value for the occurrence of SAI （sensitivity 77. 8% and specificity 92. 3%）. Condusions The decreased proportion of the auxiliary T cells after the onset of acute ischemic stroke may increase the susceptibility of SAI. The detection of T cell subsets may predict the SAI in a certain degree.

关 键 词：卒中 脑缺血 感染 T-淋巴细胞 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]