免疫抑制宿主肺炎与淋巴细胞的相关性及激素对重症患者结局的影响  

Correlation Between Immunocompromised Host Pneumonia and Lymphocyte and Influence of Glucocorticoid on Outcome of Severe Patients

作　　者：吴燕茹 曾勉[1] WU Yan-ru;ZENG Mian(Medical Intensive Care Unit,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院MICU,广东广州510080

出　　处：《中山大学学报（医学科学版）》2022年第6期976-984,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81670066);广东省自然科学基金(2019A1515011198)。

摘　　要：【目的】探究免疫抑制宿主肺炎患者外周血中淋巴细胞与疾病严重程度的相关性,和不同剂量激素使用方案对重症患者临床结局的影响。【方法】收集免疫抑制宿主肺炎患者的临床资料,根据ATS/IDSA指南重症肺炎标准,将患者分为重症组和非重症组。采用logistic回归分析筛出与免疫抑制宿主肺炎患者发展为重症肺炎相关的危险因素,并绘制受试者工作曲线(ROC)以评估各危险因素对重症免疫抑制宿主肺炎的预测价值。同时,根据重症组的激素使用情况,将重症患者分为重症+高剂量激素组(泼尼松龙用量≥1 mg·kg^(-1)·d^(-1)或等效剂量激素)、重症+低剂量激素组(泼尼松龙用量<1 mg·kg^(-1)·d^(-1)或等效剂量激素)、重症+未使用激素组,对比三组患者28 d存活率,以评估激素治疗对重症患者结局的影响。【结果】重症组淋巴细胞绝对值、T淋巴细胞百分比、T淋巴细胞绝对值、CD4^(+)T淋巴细胞绝对值均低于非重症组患者(P<0.05)。重症组IL-2、IL-4、IL-6高于非重症组患者,IFN-γ低于非重症组患者(P<0.05)。logistic回归分析:CRP及PCT的升高、PT的延长是与免疫抑制宿主肺炎患者发展为重症肺炎相关的独立危险因素,而血小板、T淋巴细胞绝对值的升高为免疫抑制宿主肺炎的独立保护因素。ROC曲线分析显示,相比于其他危险因素,T淋巴细胞绝对值计数对免疫抑制宿主肺炎患者发展至重症的风险评估具有较好的预测价值。当T淋巴细胞绝对值计数低于874.65个/µL,判断重症型的敏感度90.9%,特异度43.5%。曲线下面积(AUC)为0.723[95%CI(0.649,0.797)]。重症+高剂量激素组、重症+低剂量激素组、重症+未使用激素组3组28d存活率分别为45.5%、66.7%、25.0%,重症+低剂量激素组患者28 d存活率高于重症+未使用激素组(P<0.05);重症+低剂量激素组患者28 d存活率高于重症+高剂量激素组患者,但差异无统计学意义(P>0.05)。�【Objective】The purpose of this article is to explore the relationship between lymphocyte and the severity of immunocompromised host pneumonia,and to examine the effect of different doses of glucocorticoid on the survival out-come of severe group.【Methods】The clinical data of immunocompromised host pneumonia patients were collected.The pa-tients were divided into severe group and non-severe group according to the official clinical practice guideline of the ATS/IDSA.Logistic regression analysis was used to search for independent risk factors of severe immunocompromised host pneu-monia.Meanwhile,the receiver operating characteristic curves(ROCs)were created to evaluate the predictive value of each risk factor.Furthermore,the severe group were divided into three sub-groups according to the dose of glucocorticoid during hospitalization:severe+high-dose glucocorticoid group(≥1 mg·kg^(-1)·d^(-1)prednisolone or other equivalent dose of glucocorticoid),severe+low-dose glucocorticoid group(<1 mg·kg^(-1)·d^(-1)prednisolone or other equivalent dose of gluco-corticoid),and severe+non-glucocorticoid group.The 28-day survival rates of the three groups were compared to evaluate the effect of glucocorticoid on severe immunocompromised host pneumonia.【Results】The levels of lymphocyte absolute value,T lymphocytes percentage,T lymphocyte absolute value,CD4^(+)T lymphocyte absolute value in severe pneumonia group were lower than those in non-severe pneumonia group.The results of logistic regression showed that the increase of CRP and PCT and the prolongation of PT were independent risk factors for the severe immunocompromised host pneumo-nia,while the increase of platelet and T lymphocyte absolute value were independent protective factors for the severe im-munocompromised host pneumonia.The ROCs analysis showed that compared with other risk factors,the decrease of T lymphocyte absolute value had better predictive value for the risk assessment of immunocompromised host pneumonia.When the absolute value of T lymphocyt

关 键 词：免疫抑制宿主 肺炎 T淋巴细胞 高危因素 糖皮质激素 

分 类 号：R563.1[医药卫生—呼吸系统]