河北省老年耐药结核性胸膜炎患者细胞免疫及营养状况  

Cellular immunity and nutritional status of elderly patients with drug-resistant tuberculosis pleurisy in Hebei

作　　者：王智慧[1] 董雅坤[1] 池跃朋[1] 王玉红[1] 梁亚充 谢兰品[1] 王秋梅[1] 李晓倩 WANG Zhi-hui;DONG Ya-kun;CHI Yue-peng;WANG Yu-hong;LIANG Ya-chong;XIE Lan-pin;WANG Qiu-mei;LI Xiao-qian(Hebei Province Chest Hospital,Key Laboratory of Lung Diseases of Hebei Province,Hebei Provincial Tuberculosis Hospital,Cancer Prevention and Treatment Research Center of Hebei Province,Shijiazhuang,Hebei 050041,China)

机构地区：[1]河北省胸科医院,河北省肺病重点实验室,河北省结核病院,河北省肺癌防治研究中心,河北石家庄050041

出　　处：《中国热带医学》2021年第10期943-947,共5页China Tropical Medicine

基　　金：河北省医学科学研究重点课题(No.20180665)。

摘　　要：目的分析老年耐药结核性胸膜炎患者细胞免疫功能及营养状况,为早期对老年耐药结核性胸膜炎患者营养干预提供依据。方法收集2014年1月—2020年1月本院收治≥65岁耐药结核性胸膜炎患者的年龄、治疗次数、身体质量指数(BMI)等资料。采取患者胸腔积液经BACTEC MGIT 960结核菌培养+药敏试验,按耐药结核病分类将患者分为单耐药、多耐药、耐多药及广泛耐药;并抽取空腹静脉血进行营养及免疫相关指标检测,依据营养风险筛查量表分值(NRS2002)将患者分营养风险组(NRS2002≥3分)和无营养风险组(NRS2002<3分)。结果营养风险组与无营养风险组在年龄、诊断类型、治疗次数、BMI差异均有统计学意义(P<0.05)。随年龄增长营养风险越高,耐多药、广泛耐药、治疗次数多和BMI<18.5营养风险较高;营养风险组总蛋白(TP)、白蛋白(ALB)、血红蛋白(Hb)、预后营养指数(PNI)、CD4^(+)T、CD3^(+)T及CD4^(+)T/CD8^(+)T分别为(60.96±3.94)g/L、(32.46±3.82)g/L、(108.63±13.54)g/L、36.58±0.32、(34.20±6.73)%、(60.15±9.21)%和1.09±0.08,低于无营养风险组(69.01±3.49)g/L、(41.01±3.21)g/L、(116.68±14.84)g/L、44.21±0.28、(42.38±7.96)%、(70.02±7.99)%和(1.48±0.18),差异均有统计学意义(P<0.05)。营养风险组CD8^(+)T细胞、中性粒细胞/淋巴细胞比值(NLR)及住院天数分别为(38.64±7.56)%、6.48±0.32及(28.28±2.10)d明显高于无营养风险组(26.55±5.98)%、4.12±0.12及(21.12±1.25) d,差异有统计学意义(P<0.05);营养风险组NK细胞、B淋巴细胞、IgG、IgA、IgM分别为(9.98±6.46)%、(11.21±6.45)%、(12.25±6.48)g/L、(2.16±0.28)g/L及(1.41±0.48)g/L与无营养风险组比较(10.38±4.89)%、(10.42±6.89)%、(11.76±5.19)g/L、(2.15±0.32)g/L、(1.38±0.54)g/L,差异均无统计学意义(P>0.05)。结论细胞免疫功能及营养评估在老年耐药结核性胸膜炎患者治疗及预后推断有重要意义。营养风险发生率与年龄、治疗次数呈正�Objective To analyze the cellular immune function and nutritional status of elderly patients with drugresistant tuberculosis pleurisy, and we provide basis for nutritional intervention in the early stage of elderly patients with drugresistant tuberculosis pleurisy.Methods A total of 128 patients with drug-resistant tuberculous pleurisy aged ≥65 years who were admitted to our hospital from January 2014 to January 2020 were retrospectively collected, general information, including age, number of treatments, body mass index(BMI), etc of patients was recorded. The pleural effusion of all enrolled patients was collected for BACTEC MGIT 960 tuberculosis culture and drug sensitivity test, according to the classification of drug-resistant tuberculosis, the enrolled patients were divided into single drug-resistant, poly-drug-resistant, multi-drug-resistant and extensively drug-resistant;and fasting elbow venous blood was collected from morning, and nutritional and immune-related indexes were detected;The 128 patients were divided into nutritional risk group(NRS 2002 score≥3) and non-nutritional risk group(NRS 2002 score<3).Results The analysis results showed that there were statistically significant differences in age,type of diagnosis, frequency of treatment and BMI between the nutritional risk group and the non-nutritional risk group(P<0.05). Along with the age increasing nutritional risk was higher, multidrug-resistant and extensively drug-resistant, treatment more and BMI<18.5 nutritional risk was higher;nutritional and immune-related detection indexes showed that the level of total protein(TP), albumin(ALB), hemoglobin(Hb), prognostic nutrition index(PNI), CD4^(+)T cells, CD3^(+)T cells and CD4^(+)T/CD8^(+)T in nutritional risk group [(60.96±3.94) g/L,(32.46±3.82) g/L,(108.63±13.54) g/L, 36.58±0.32,(34.20±6.73) %,(60.15±9.21) %and 1.09±0.08] were lower than those in non-nutritional risk group[(69.01±3.49) g/L,(41.01±3.21) g/L,(116.68±14.84) g/L,44.21±0.28,(42.38±7.96) %,(70.02±7.99) %和(1.48±0.18)]

关 键 词：老年 耐药结核性胸膜炎 细胞免疫 营养评估 

分 类 号：R521.1[医药卫生—内科学]