大面积脑梗死合并肺部感染外周血T淋巴细胞亚群及CD_(4)^(+)/CD_(8)^(+)比值水平变化及意义  

Changes and significance of peripheral blood T lymphocyte subsets and CD_(4)^(+)/CD_(8)^(+) ratio in large hemispheric infarction with pulmonary infection

作　　者：吕颖 吴珺 徐蕤[3] 孟德志 杨帆[4] LYU Ying;WU Jun;XU Rui;MENG De-zhi;YANG Fan(Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038,China;不详)

机构地区：[1]首都医科大学附属北京世纪坛医院神经与精神科,北京100038 [2]首都医科大学附属北京世纪坛医院全科医学科,北京100038 [3]北京丰台医院重症医学科,北京100038 [4]北京丰台医院神经内科,北京100038

出　　处：《中华医院感染学杂志》2021年第16期2447-2451,共5页Chinese Journal of Nosocomiology

基　　金：北京市重点实验室基金资助项目(BZ0089)。

摘　　要：目的探究大面积脑梗死(LHI)合并肺部感染(PI)患者外周血T淋巴细胞亚群及CD_(4)^(+)/CD_(8)^(+)比值水平的动态变化及意义。方法收集医院2011年3月-2017年5月收治的100例LHI合并PI患者资料进行回顾性分析,检测患者入院时、3 d、7 d外周血T淋巴细胞亚群水平,依据格拉斯哥昏迷评分(GCS)、临床肺部感染评分(CPIS)、28 d时改良Rankin量表评分评估患者LHI、PI病情严重程度以及预后情况并进行分组,比较不同病情严重程度以及预后患者入院后外周血T淋巴细胞亚群及CD_(4)^(+)/CD_(8)^(+)比值水平的动态变化及其临床意义。结果三组患者入院时、住院3 d、住院7 d时,重度组患者CD3+、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)比值低于轻度组与中度组,CD_(8)^(+)T均高于轻度组与中度组,中度组患者CD3+、CD_(4)^(+)T、CD_(4)^(+)/CD_(8)^(+)比值低于轻度组,CD_(8)^(+)T均高于轻度组(P<0.05);轻度组PI患者入院时CD3+、CD_(4)^(+)水平及CD_(4)^(+)/CD_(8)^(+)比值均高于中重度组,CD_(8)^(+)水平低于中重度组(P<0.05);预后良好组患者入院时CD3+、CD_(4)^(+)T淋巴细胞亚群水平及CD_(4)^(+)/CD_(8)^(+)比值高于预后不佳组,CD_(8)^(+)水平低于预后不佳组(P<0.05);ROC曲线结果显示患者入院时CD3+、CD_(8)^(+)、CD_(4)^(+)以及CD_(4)^(+)/CD_(8)^(+)预测患者预后曲线下面积(AUC)分别为0.855、0.871、0.729、0.557。结论LHI合并PI患者外周血T淋巴细胞亚群及CD_(4)^(+)/CD_(8)^(+)比值水平动态变化与患者病情严重程度有关,可用于预测患者预后情况。OBJECTIVE To explore the dynamic changes and significance of peripheral blood T lymphocyte subsets and CD_(4)^(+)/CD_(8)^(+)ratio in patients with large hemispheric infarction(LHI)and pulmonary infection(PI).METHODS A retrospective analysis was performed on the data of 100 LHI patients complicated with PI who were admitted to hospital between Mar 2011 and May 2017.Peripheral blood T lymphocyte subsets were detected on the day of admission,3 d and 7 d after admission.The Glasgow Coma Scale(GCS),the clinical pulmonary infection score(CPIS)and the modified Rankin scale on Day 28 were used to assess the severity of LHI and PI and prognosis in patients.Based on the evaluation results,patients were divided into groups and dynamic changes of peripheral blood T lymphocyte subsets and CD_(4)^(+)/CD_(8)^(+)ratio,and their clinical significance in patients with different severity of disease and different prognosis were analyzed.RESULTS The CD3+and CD_(4)^(+)T-cells and CD_(4)^(+)/CD_(8)^(+)ratio in patients with LHI in the severe group,moderate group and mild group increased in order,while CD_(8)^(+)in the three groups decreased sequentially(P<0.05).CD3+and CD_(4)^(+)T-cells and CD_(4)^(+)/CD_(8)^(+)ratio in the good prognosis group were significantly higher than those in the poor prognosis group,and the levels of CD_(8)^(+)T-cells was significantly lower than that in the poor prognosis group(P<0.05).ROC curve showed that the area under the curve(AUC)values of CD3+,CD_(8)^(+)and CD_(4)^(+)T-cells and CD_(4)^(+)/CD_(8)^(+)ratio for predicting poor prognosis were 0.855,0.871,0.729,and 0.557,respectively.CONCLUSION Dynamic changes of peripheral blood T lymphocyte subsets and CD_(4)^(+)/CD_(8)^(+)ratio in patients with LHI and PI are related to the degree of patient’s severity,which can be used to predict the prognosis.

关 键 词：大面积脑梗死 肺部感染 外周血T淋巴细胞亚群 CD_(4)^(+)/CD_(8)^(+)比值 动态变化 临床意义 

分 类 号：R563.1[医药卫生—呼吸系统]