外周血Th17细胞对呼吸机相关性肺炎的早期诊断价值  

Early diagnosis value of peripheral Th17 cells levels on ventilator associated pneumonia

作　　者：张鹏[1] 周健[1] 王耀丽[1] 卢海滨[1] 杨雪飞[1] 马凌云[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所重症医学科,重庆400042

出　　处：《中华肺部疾病杂志（电子版）》2016年第2期150-153,共4页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金青年项目(81200057)

摘　　要：目的探讨外周血Th17细胞水平对呼吸机相关性肺炎(VAP)的早期诊断价值。方法收集本院2011年04月至2015年04月510例机械通气时间超过48 h患者的临床资料,根据是否发生VAP将其分为VAP组(95例)与非VAP组(415例)。采用流式细胞仪检测二组患者的外周血Th17细胞水平,酶联免疫吸附法(ELISA)检测细胞因子白细胞介素-17(IL^(-1)7)、白细胞介素-6(IL-6)水平,并同时记录临床肺部感染评分(CPIS)情况,分别比较二组患者外周血Th17细胞及IL^(-1)7、IL-6水平的差异以及Th17细胞水平与CPIS评分的相关性,评价外周血Th17细胞水平对VAP患者的早期诊断价值。结果VAP组患者外周血Th17细胞及IL^(-1)7、IL-6水平明显高于非VAP组患者(P<0.05);经过抗感染治疗后,VAP组患者外周血Th17细胞、IL^(-1)7、IL-6水平及CPIS评分均较治疗前显著降低(P<0.05)。相关性分析显示,外周血Th17细胞水平与CPIS评分呈显著正相关(r=0.69,P<0.01)。ROC曲线分析显示,以外周血Th17细胞比例>7.4%为早期诊断VAP界限时,诊断VAP的敏感性和特异性分别为83.6%和89.1%,ROC曲线下面积(AUC)为0.885(95%CI 0.794~0.918)。结论 VAP患者早期外周血Th17细胞水平显著升高,并且与CPIS评分具有较好的相关性,检测外周血Th17细胞水平可作为早期诊断VAP的有效指标。Objective To study the clinical value of Th17 cell levels on the early diagnosis of ventilator associated pneumonia（ VAP）. Methods A total of 510 patients,who undergone mechanical ventilation over 48 h in our hospital from April 2011 to April 2015 were enrolled in the study. According to the related infections,these patients were divided the VAP group（ 95 cases） and non-VAP group（ 415 cases）.The percentages of Th17 cells were measured by flow cytometry,Serum levels of cytokines,interleukin-17（ IL-17）,interleukin-16（ IL-6） were measured by enzyme linked immunosorbent assay（ ELISA） and clinical pulmonary infection score（ CPIS） score were analyzed. The differences of Th17 cells levels and IL-17,IL-6were compared and correlation with CPIS score were analyzed,which the relationship with the early diagnosis of VAP were also assessed. Results Th17 cells,IL-17 and IL-6 levels in VAP group were significantly higher than non-VAP group（ P〈0. 05）; After the treatment,the levels of Th17 cells,IL-17 and IL-6 levels,and CPIS score were significantly decreased in VAP group（ P〈0.05）. The Th17 cells levels and CPIS score were positive correlated（ r = 0.69,P〈0.01）. ROC curves analysis results showed that with Th17 cell levels 7. 4%considered as the boundary for diagnosis of VAP,the sensitivity was 83. 6%,the specificity was 89. 1%,the area under curve of Th17 cell levels was 0.885（ 95%CI 0.794-0.918）. Conclusion The peripheral Th17 cells levels of VAP are significantly increased,and have a good correlation with CPIS score. The Th17 cells levels can be used as an early diagnostic maker for VAP.

关 键 词：呼吸机相关性肺炎 辅助Th17细胞 白细胞介素-17 诊断 早期 

分 类 号：R563[医药卫生—呼吸系统]