慢性心力衰竭患者肺部感染的临床特征及免疫功能分析  

Clinical symptoms and immune function of chronic heart failure patients with pulmonary infections

作　　者：邸军军[1] 岳玉国[1] 赵新国[1] 罗建华[1] 陈奕[1] 

机构地区：[1]武警浙江省总队嘉兴医院心内科,浙江嘉兴314000

出　　处：《中华医院感染学杂志》2017年第6期1263-1266,1278,共5页Chinese Journal of Nosocomiology

基　　金：浙江省中西医结合学会科研基金资助项目(2013LYSX094)

摘　　要：目的分析慢性心力衰竭患者发生肺部感染的临床状况及免疫功能,探讨分离出的各种菌株耐药性。方法选择2015年6月-2016年6月医院接诊280例慢性心力衰竭患者,根据住院期间患者发生肺部感染与否,分为观察组124例和对照组156例,分析两组患者的一般临床资料,观察合并肺部感染患者的临床表现及感染相关因素,比较两组患者T淋巴细胞亚群和血清免疫球蛋白水平,分析病原菌的耐药性及两组患者的预后情况等,分析肺部感染危险因素。结果两组患者住院时间和糖尿病史差异有统计学意义(P<0.05);慢性心力衰竭患者肺部感染后出现咳嗽、发热、胸痛等呼吸系统典型症状患者58例占46.77%;痰培养结果显示,124例患者培养致病菌108株,革兰阴性菌占48.15%,革兰阳性菌占30.56%,真菌23株占21.29%;两组患者免疫功能分析比较显示,两组患者CD_8^+、CD_4^+/CD_8^+、IgG和IgM水平差异有统计学意义(P<0.05);两组患者在CD_4^+和IgA水平方面差异无统计学意义;两组患者在肺部感染因素中,平均NYHA分级、有创检查/治疗、制酸剂和预防应用抗菌药物方面差异有统计学意义(P<0.05)。结论慢性心力衰竭患者极易出现肺部感染,临床症状较多,病原菌构成复杂,应根据药敏试验结果选用合适的抗菌药物,以达到控制和预防医院感染的目的。OBJECTIVE To investigate the clinical symptoms and immune function of chronic heart failure patients with pulmonary infections and explore the drug resistance of isolated pathogenic bacteria .METHODS A total of 280 patients with chronic heart failure who were treated in the hospital from Jun 2015 to Jun 2016 were enrolled in the study and divided into the observation group with 124 cases and the control group with 156 cases according to the status whether the pulmonary infections occurred during the hospital stay .The baseline data of the two groups of patients were analyzed ,the clinical manifestations of the patients complicated with pulmonary infections and the related factors for the infections were observed ,the T lymphocyte subsets and serum immunoglobulin levels were compared between the two groups of patients , the drug resistance of the pathogens and prognosis of the two groups of patients were observed ,and the risk factors for the pulmonary infection were analyzed .RESULTS There was significant difference in the length of hospital stay or history of diabetic mellitus between the two groups of patients （P〈0 .05） .There were 58 （46 .77% ） chronic heart failure patients who had typical respiratory system symptoms such as cough ,fever ,chest pain after they had the pulmonary infections .The result of sputum culture indicated that totally 108 strains of pathogenic bacteria were isolated from 124 patients ,of which 48 .15% were gram-negative bacteria ,30 .56% were gram-positive bacteria ,and 21 .29% （23 strains） were fungi .The analysis of immune function of the two groups of patients showed that there was significant difference in the CD 8^＋ ,CD4^＋ /CD8^＋ ,IgG ,or IgM level between the two groups of patients （P〈0 .05）;there was no significant difference in the CD4^＋ or IgA level between the two groups of patients .As compared with the factors for the pulmonary infections , there was significant difference in the mean NYHA classification ,invasive examination or treatment ,antacid

关 键 词：慢性心力衰竭 肺部感染 临床状况 免疫功能 

分 类 号：R563.1[医药卫生—呼吸系统]