重症肺炎患者的病原学特点及预后相关因素分析  

Analysis of pathogenic characteristics and prognostic factors in patients with severe pneumonia

作　　者：周雨蒙 张铁栓[1] 邵润霞[1] 张筠[1] ZHOU Yumeng;ZHANG Tieshuan;SHAO Runxia;ZHANG Yun(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,Henan,China)

机构地区：[1]郑州大学第二附属医院呼吸与危重症医学科,河南郑州450014

出　　处：《中国现代医生》2023年第33期41-44,48,共5页China Modern Doctor

摘　　要：目的探讨重症肺炎患者的病原学特点及淋巴细胞亚群、降钙素原(procalcitonin,PCT)、中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、急性生理和慢性健康评分系统Ⅱ(acute physiological and chronic health evaluation scoring systemⅡ,APACHEⅡ)等指标与疾病预后的关系。方法选取2018年1月至2022年1月在郑州大学第二附属医院住院的重症肺炎患者85例,根据治疗1个月内的情况,将患者分为预后不良组和预后良好组。采集患者的气道深部痰液标本进行病原菌检测,分析重症肺炎的病原菌分布,同时采集患者的血液标本,比较两组患者的淋巴细胞亚群、淋巴细胞计数(lymphocyte count,LYM)、PCT、NLR、APACHEⅡ评分等,并采用Pearson相关法分析上述指标与APACHEⅡ评分的相关性。结果①重症肺炎患者治疗1个月内,预后不良发生率为55.29%。②85例患者痰液标本中共检出病原菌101株,其中革兰阴性菌69株,革兰阳性菌27株,真菌5株。③不同预后组间的革兰阴性菌和鲍曼不动杆菌比较差异有统计学意义(P<0.05),两组间的其他病原菌比较差异无统计学意义(P>0.05)。④预后不良组患者的PCT、NLR、APACHEⅡ评分均高于预后良好组患者(P<0.05),两组患者的年龄、性别、C反应蛋白(C-reactive protein,CRP)、D-二聚体(D-dimer,D-D)差异无统计学意义(P>0.05);与预后良好组比较,预后不良组患者的LYM、T、CD4^(+)T淋巴细胞均降低,B淋巴细胞升高,差异有统计学意义(P<0.05),两组患者的CD8^(+)T、NK细胞差异无统计学意义(P>0.05)。⑤血清PCT、NLR、B淋巴细胞与APACHEⅡ评分呈正相关,LYM、T、CD4^(+)T淋巴细胞与APACHEⅡ呈负相关(P<0.01)。结论①重症肺炎的病原学特点以革兰阴性菌为主,主要是鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌。②淋巴细胞亚群及炎性指标的变化对疾病严重程度和预后评估具有重要指导意义。Objective To investigate the pathogenic characteristics of severe pneumonia and the relationship between lymphocyte subsets,procalcitonin(PCT),neutrophil/lymphocyte ratio(NLR),acute physiological and chronic health evaluation scoring systemⅡ(APACHEⅡ)and the prognosis of the disease.Methods A total of 85 severe pneumonia patients admitted to the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2022 were selected.The prognosis within one month after treatment was statistically analyzed and divided into poor prognosis group and good prognosis group.Sputum samples from deep airways of severe pneumonia patients were collected for pathogenic bacteria examination to understand the distribution of pathogenic bacteria in severe pneumonia.The blood samples of the patients were collected,and the lymphocyte subsets,lymphocyte count(LYM),PCT,NLR,APACHEⅡscore were compared between the two groups.Pearson correlation method was used to analyze the correlation between the above indexes and APACHEⅡscore.Results①The incidence of poor prognosis in patients with severe pneumonia was 55.29%within 1 month of treatment.②A total of 101 strains of pathogenic bacteria were detected in sputum samples of 85 patients,including 69 gram-negative bacteria,27 gram-positive bacteria and 5 fungi.③There were statistically significant differences in gram-negative bacteria and Acinetobacter baumannii among different groups(P<0.05),while there were no significant difference in other pathogens between the two groups(P>0.05).④The PCT,NLR and APACHEⅡscore in poor prognosis group were higher than those in good prognosis group(P<0.05),while there were no significant difference in age,gender,C-reactive protein(CRP)and D-dimer(D-D)between the two groups(P>0.05);Compared with good prognosis group,LYM,T,CD4^(+)T cell levels in poor prognosis group were decreased,and the B lymphocyte levels were increased,and the differences were statistically significant(P<0.05),there were no significant difference in CD8^(+)T an

关 键 词：重症肺炎 病原菌 淋巴细胞亚群 炎症标志物 

分 类 号：R563.1[医药卫生—呼吸系统]