检测单核细胞HLA-DR和T淋巴细胞亚群变化对脑卒中相关性肺炎的预测价值  

Value of monocyte HLA-DR expression and T cell subsets in predicting stroke-associated pneumonia

作　　者：张新颜[1] 闫福岭[2] 邵伟波[1] 何逸康[3] 

机构地区：[1]南京医科大学附属南京脑科医院康复医学科,210029 [2]东南大学附属中大医院神经内科,210009 [3]东南大学附属中大医院康复医学科,210009

出　　处：《中国神经免疫学和神经病学杂志》2013年第6期396-399,共4页Chinese Journal of Neuroimmunology and Neurology

基　　金：南京市科技发展计划基金资助项目(201201105);南京医科大学科技发展基金资助项目(2012NJMU119)

摘　　要：目的 探讨急性脑卒中后单核细胞表面人类白细胞抗原-DR（human leucocyte antigen-DR,HLA-DR）表达和T淋巴细胞亚群变化对脑卒中相关性肺炎（stroke-associated pneumonia,SAP）发生的预测价值.方法 连续入选发病后24 h内入院的急性脑卒中患者,根据起病1周内是否发生SAP将患者分为SAP组和非SAP组.应用单因素和多因素Logistic回归分析探寻SAP发生的独立预测因素,并使用受试者工作特征（receiver operating characteristic,ROC）曲线评估其预测价值.结果 共入选64例急性脑卒中患者,其中19例发生SAP,发生率为29.69％.SAP组单核细胞HLA-DR表达率、淋巴细胞计数、CD3＋T淋巴细胞计数、CD4＋T淋巴细胞计数、CD8＋T淋巴细胞计数低于非SAP组（均P＜0.05）,而白细胞计数,中性粒细胞计数和美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分高于非SAP组（均P＜0.05）.多因素Logistic回归分析显示,在排除NIHSS评分影响后,单核细胞HLA-DR表达率对SAP的发生具有预测价值（OR=0.919,95％CI：0.879～0.960,P=0.000）,单核细胞HLA-DR低于79.5％是预测SAP发生的一个有用截断点（ROC曲线下面积0.823,敏感度73.7％,特异度89.5％,P=0.000）.结论 脑卒中诱导的细胞免疫抑制在SAP患者中表现更明显.脑卒中早期的单核细胞HLA-DR表达率对SAP的发生有预测价值,有助于早期识别发生SAP的高危患者.Objective To investigate the value of HLA-DR expression in circling monocyte （mHLA-DR） and T cell subsets predicting stroke-associated pneumonia （SAP） in patients with acute stroke.Methods The consecutive patients with acute stroke admitted to hospital within 24 hours after symptom onset.They were divided into the SAP group and the non-SAP group according to whether they had SAP or not within one week after symptom onset.Univariate and multivariate logistic recession analysis were used to analyze the data.The predictive factors were identified and analyzed with receiver operating characteristic （ROC） curves in order to assess their predictive value for SAP.Results Of the 64 patients with acute stroke,19 （29.69%） had SAP.Univariate analysis showed that mHLA-DR expression percentage,lymphocyte counts,CD3＋T lymphocyte counts,CD4＋T lymphocyte counts and CD8＋ T lymphocyte counts in the SAP group were significantly lower than those in the non-SAP group （all P〈0.05） while the leukocyte counts,neutrophil counts,NIHSS score were significantly higher than those in the non-SAP group （all P〈 0.05）.Multivariate logistic regression analysis showed that low mHLA-DR expression was the independent risk factors for SAP in stroke patients （OR =0.919,95% CI：0.879-0.960,P=0.000）.The percentage of mHLA-DR expression ≤79.5% had good predictive value for SAP when the effect of NIHSS was controlled,and its sensitivity and specificity were 73.7% and 89.5% respectively （P=0.000）.Conclusions Stroke-induced cell immune suppression is more evident in patients who have SAP.Monocyte HLA-DR expression within 24 hours after stroke has predictive value for SAP occurrence,and contributes to the early identification of patients at high risk of SAP. Keywords：stroke; pneumonia; HLA-DR antigen; T lymphocyte subsets

关 键 词：卒中 肺炎 HLA-DR抗原 T淋巴细胞亚群 

分 类 号：R743.3[医药卫生—神经病学与精神病学]