重症肺炎患者早期免疫功能变化对疗效及预后的影响  

Effect of immune function changes on therapeutic effectiveness and prognosis in the early stage of severe pneumonia

作　　者：王凡[1] 陈旭昕 孟激光 Wang Fan;Chen Xuxin;Meng Jiguang(Department of Respiratory and Critical Care Medicine,the Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心呼吸与危重症医学科,北京100048

出　　处：《国际呼吸杂志》2021年第18期1393-1397,共5页International Journal of Respiration

基　　金：解放军总后勤部卫生部科研基金(17BJZ04);北京市自然科学基金(7182163);海军总医院创新培育基金(CXPY201725)。

摘　　要：目的探讨重症肺炎患者早期免疫功能变化对疗效及预后的影响。方法前瞻性研究。收集2018年1月至2019年12月解放军总医院第六医学中心收治的46例重症肺炎患者,分别于入院第1、3、7天评估患者的血常规、C反应蛋白(CRP)、临床肺部感染评分(CPIS)、T淋巴细胞亚群及血清免疫球蛋白IgA、IgM、IgG,根据患者治疗7 d的疗效分为好转组和恶化组,比较2组淋巴细胞总数、T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)及血清免疫球蛋白IgA、IgM、IgG的变化,观察终点为患者最终好转出院或死亡。结果好转组27例,恶化组19例,最终恶化组中死亡15例,其余患者均存活。随着治疗时间延长,好转组CPIS评分逐渐降低,恶化组逐渐升高,分别为(7.44±1.19)分、(7.44±1.58)分、(5.96±1.53)分比(7.47±1.35)分、(7.79±1.44)分、(8.41±1.12)分,在组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05);好转组淋巴细胞总数、CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD8^(+)T淋巴细胞均逐渐升高,而恶化组较前变化不大或者降低,在组间·时点间交互作用差异均有统计学意义(P<0.05);2组IgA、IgM、IgG均无明显变化,在组间、时点间、组间·时点间交互作用差异均无统计学意义(P>0.05)。结论重症肺炎患者细胞免疫功能能否早期恢复是评估早期治疗效果、预示疾病转归的重要因素。Objective To study the effect of immune function changes on therapeutic effectiveness and prognosis in the early stage of severe pneumonia.Methods Perspective reseach was performed in 46 patients with severe pneumonia who admitted to the Sixth Medical Center of PLA General Hospital from January 2018 to December 2019.Blood routine test,C-reactive protein(CRP),clinical pulmonary infection score(CPIS),T lymphocyte subsets,serum immunoglobulin IgA,IgM and IgG were evaluated on the 1st,3rd and 7th day after admission.According to the therapeutic effectiveness of 7 days of treatment,the patients were divided into improvement group and deterioration group.The total number of lymphocytes,lymphocyte subsets CD3^(+),CD4^(+),CD8^(+),immunoglobulin IgA,IgM and IgG between two groups were compared.The endpoint was survival or death.Results There were 27 cases in the improvement group and 19 cases in the deterioration group(15 cases of this group died finally).With the prolongation of treatment,CPIS score decreased gradually in the improvement group and increased in the deterioration group.(7.44±1.19)scores,(7.44±1.58)scores,(5.96±1.53)scores vs(7.47±1.35)scores,(7.79±1.44)scores,(8.41±1.12)scores.There were significant differences in groups,time points and the interaction between groups and time points(P<0.05).The total number of lymphocytes,CD3^(+)T lymphocytes,CD4^(+)T lymphocytes and CD8^(+)T lymphocytes increased gradually in the improvement group,and there was no change or decrease in the deterioration group.There was significant difference in the interaction between groups and time points(P<0.05).There was no significant difference in IgA,IgM and IgG between the two groups,and there was no significant difference in groups,time points and the interaction between groups and time points(P>0.05).Conclusions Recovery of cellular immune function in early stage of severe pneumonia is important to evaluate the therapeutic effectiveness and prognosis of the patients.

关 键 词：肺炎 免疫测定 治疗结果 预后 

分 类 号：R563.1[医药卫生—呼吸系统]