重症颅内感染患者的炎症和免疫功能评估及与预后的相关性研究  

Assessment of Inflammation and Immune Function in Patients with Severe Intracranial Infection and Its Correlation with Prognosis

作　　者：卞毅[1] 黄姝 许峰[2] 梁奇明[2] 王芙蓉 张萍[2] BIAN Yi;HUANG Shu;XU Feng;LIANG Qi-ming;WANG Fu-rong;ZHANG Ping(Department of Emergency&Intensive Care Unit,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院急诊与重症医学科,武汉430030 [2]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《神经损伤与功能重建》2020年第8期446-448,460,共4页Neural Injury and Functional Reconstruction

基　　金：湖北省自然科学基金青年项目(No.2018CFB115、2019CFB107)。

摘　　要：目的:探讨重症颅内感染患者的炎症和免疫特征,并研究与预后的相关性。方法:回顾2018年12月至2019年12月我院神经内科重症监护病房收治的62例重症颅内感染患者的临床资料,收集其一般人口学信息、诊断及治疗经过、炎症因子指标、免疫功能指标及预后,进行统计学分析和处理。结果:62例患者的最低格拉斯哥昏迷量表(GCS)评分中位数为9分(IQR 6~12),其中30例(48.4%)接受机械通气,在院死亡率为4.8%。炎症相关指标中,白细胞计数、中性粒细胞计数、超敏C反应蛋白(hs-CRP)、降钙素原(RCT)、血沉、促炎因子白细胞介素(IL)-2受体、IL-6和肿瘤坏死因子(TNF)-α均高于正常值,淋巴细胞计数低于正常值。细胞免疫指标中,总T淋巴细胞、CD4+T细胞、CD8+T细胞和NK细胞亚群计数均显著低于正常范围。严重意识障碍患者(GCS评分≤8分)机械通气率、在院死亡率和hs-CRP水平显著增高。接受机械通气的患者GCS评分显著降低,中性粒细胞计数、hs-CRP和RCT水平显著增高。结论:重症颅内感染患者炎症指标显著增高,细胞免疫指标明显异常。hs-CRP等炎症指标在一定程度上与重症颅内感染患者的病情严重程度及预后相关。Objective: This study investigated the characteristics of inflammatory and immune changes in patients with severe intracranial infection and examined their correlation with prognosis. Methods: We reviewed the clinical data of 62 patients with severe intracranial infection admitted to the neurological intensive care unit of our hospital from December 2018 to December 2019. General demographic information, diagnosis and treatment, inflammatory indicators, immune function indicators, and prognosis were collected for statistical analysis. Results: These 62 patients had a median lowest Glasgow coma scale(GCS) score of 9(IQR: 6-12);30(48.4%) received mechanical ventilation;in-hospital mortality rate was 4.8%. Among the inflammatory indicators, white blood cell count, neutrophil count, hypersensitive C-reactive protein(hs-CRP), procalcitonin(PCT),erythrocyte sedimentation rate, IL-2 receptor, IL-6, and TNF-α were all higher than normal while lymphocyte count was lower than normal. Among the cellular immunity indicators, the total T lymphocyte, CD4 + T cell,CD8+ T cell, and NK cell counts were significantly below the normal range. Patients with severe unconsciousness(GCS score ≤8) had significantly increased mechanical ventilation rates, hospital mortality, and hs-CRP levels. Patients who accepted mechanical ventilation had significantly lower GCS scores and significantly higher neutrophil counts and hs-CRP and procalcitonin levels. Conclusion: Patients with severe intracranial infection showed significant increases in inflammatory indicators and significant abnormalities in cellular immunity indicators. To some extent, inflammatory indicators such as hs-CRP are correlated with the severity and prognosis of patients with severe intracranial infection.

关 键 词：颅内感染 神经重症监护病房 炎症因子 免疫功能 淋巴细胞亚群 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学]