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  

Evaluating prognosis of hospital-acquired pneumonia in elderly patients by using T cell subsets and clinical pulmonary infection score

作　　者：李莲花[1] 杨倩[1] 栾禹博 晁彦公[1] 王仲 

机构地区：[1]北京华信医院(清华大学第一附属医院)急诊重症监护病房,北京100016 [2] 北京清华医院

出　　处：《中华急诊医学杂志》2014年第4期377-381,共5页Chinese Journal of Emergency Medicine

摘　　要：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＆#177;标准差（（x）＆#177;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�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 ＆amp; 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 ＆#177; 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 patie

关 键 词：院内获得性肺炎 T细胞亚群 临床肺部感染评分 预后 

分 类 号：R563.1[医药卫生—呼吸系统]