急性脑梗死患者并发脑卒中相关性肺炎外周血T淋巴细胞亚群与炎症因子的临床分析  

Predictive value of T lymphocyte subsets and inflammatory factors for occurrence and severity of stroke associated pneumonia in patients with acute cerebral infarction

作　　者：任厚伟[1] 顾彬[1] 郭婷[2] 刘旭波[1] 王茜[2] 王栋 卫增震 张甜 杨鹏[3] 王君[1] Ren Houwei;Gu Bin;Guo Ting;Liu Xubo;Wang Qian;Wang Dong;Wei Zengzhen;Zhang Tian;Yang Peng;Wang Jun(Department of Emergency,Taizhou People’s Hospital,Taizhou 225300,Jiangsu Province,China;Central Laboratory,Taizhou People’s Hospital,Taizhou 225300,Jiangsu Province,China;Department of Emergency,The First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]江苏省泰州市人民医院急诊科,225300 [2]江苏省泰州市人民医院中心实验室,225300 [3]苏州大学第一附属医院急诊科,215000

出　　处：《中华临床感染病杂志》2020年第6期406-411,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金(81701213);泰州市人民医院院级科研基金(ZL201822)。

摘　　要：目的分析急性脑梗死(Acute cerebral infarction,ACI)患者外周血T淋巴细胞亚群与炎症因子对脑卒中相关性肺炎(Stroke associated pneumonia,SAP)的预测价值。方法回顾性分析2017年1月至2019年12月泰州市人民医院收治的225例ACI患者临床资料,根据是否发生SAP分为SAP组(n=86)和非SAP组(n=139)。收集所有患者入院时的临床资料,包括年龄、性别、血常规、T淋巴细胞亚群和炎症因子指标等。采用多因素Logistic回归分析ACI患者发生SAP的危险因素,并通过受试者工作特征曲线(ROC)分析不同指标预测SAP的价值。同时根据SAP病情严重程度评分系统将SAP患者分为低危38例,中危28例,高危20例,分析各组间外周血T淋巴细胞亚群和炎症因子的差异性。采用SPSS 23统计学软件分析数据。结果多因素Logistic回归分析显示,美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.113,95%CI 1.029~1.196,P<0.05)、血小板/淋巴细胞比值(PLR)(OR=1.035,95%CI 1.012~1.060,P<0.05)、C-反应蛋白(CRP)(OR=1.078,95%CI 1.009~1.091,P<0.05)为SAP发生的独立危险因素,而淋巴细胞计数(OR=0.424,95%CI 0.198~0.910,P<0.05)、CD4^(+)/CD8^(+)T淋巴细胞比值(OR=0.020,95%CI 0.002~0.280,P<0.05)为SAP发生的保护性因素。ROC曲线分析显示,NIHSS评分(AUC=0.920,95%CI 0.877~0.952,P<0.05)、淋巴细胞计数(AUC=0.860,95%CI 0.807~0.902,P<0.05)和CD4^(+)/CD8^(+)T淋巴细胞比值(AUC=0.871,95%CI 0.820~0.912,P<0.05)对SAP的预测价值较CRP(AUC=0.671,95%CI 0.606~0.732,P<0.05)和PLR(AUC=0.645,95%CI 0.578~0.707,P<0.05)大。高危SAP患者的NIHSS评分和CRP均高于低危SAP患者(t=2.341和3.058,P<0.05),而淋巴细胞计数和CD4^(+)/CD8^(+)T淋巴细胞比值均低于低危SAP患者(t=4.799和4.103,P<0.05)。高危SAP患者的CD4^(+)/CD8^(+)T淋巴细胞比值低于中危SAP患者(t=4.085,P<0.05)。结论ACI患者的病情严重程度、外周血淋巴细胞计数、CD4^(+)/CD8^(+)T淋巴细胞比值及CRP对SAP的发生及严重程度分级有预测价值�Objective To assess the predictive value of peripheral blood T lymphocyte subsets and inflammatory factors for occurrence and severity of stroke associated pneumonia(SAP)in patients with acute cerebral infarction(ACI).Methods Clinical data of 225 patients with ACI admitted to Taizhou People’s Hospital from January 2017 to December 2019 were retrospectively analyzed.According to the occurrence of SAP,the patients were divided into SAP group(n=86)and non-SAP group(n=139).General clinical data were collected for all patients at admission,including age,sex,blood routine and inflammation-related factors.Multivariate Logistic regression was used to analyze the risk factors for SAP in ACI patients,and the value of predicting the occurrence of SAP was analyzed by the receiver operating characteristic(ROC)curve.At the same time,SAP patients were divided into 38 cases of low-risk SAP,28 cases of medium-risk SAP,and 20 cases of high-risk SAP according the severity rating system of SAP,and the differences of peripheral blood T-lymphocyte subsets and inflammatory factors among each group were analyzed.SPSS 23 statistical software was used to analyze the data.Results Multivariate Logistic regression analysis showed that national institute of health stroke scale(NIHSS)score(OR=1.113,95%CI 1.029-1.196,P<0.05),platelet-lymphocyte ratio(PLR)(OR=1.035,95%CI 1.012-1.060,P<0.05),C-reacting protein(CRP)(OR=1.078,95%CI 1.009-1.091,P<0.05)were independent risk factors for SAP,while lymphocyte count(OR=0.424,95%CI 0.198-0.910,P<0.05)and CD4^(+)/CD8^(+)T lymphocyte ratio(OR=0.020,95%CI 0.002-0.280,P<0.05)were protective factors for SAP.ROC curve analysis showed that NIHSS score(AUC=0.920,95%CI 0.877-0.952,P<0.05),lymphocyte count(AUC=0.860,95%CI 0.807-0.902,P<0.05)and CD4^(+)/CD8^(+)T lymphocyte ratio(AUC=0.871,95%CI 0.820-0.912,P<0.05)had higher predictive value for SAP than CRP(AUC=0.671,95%CI 0.606-0.732,P<0.05)and PLR(AUC=0.645,95%CI 0.578-0.707,P<0.05).NIHSS score and CRP levels of high-risk SAP patients were higher than those of l

关 键 词：肺炎 脑卒中相关性肺炎 脑梗死 T淋巴细胞亚群 炎症因子 

分 类 号：R743.3[医药卫生—神经病学与精神病学]