老年急性缺血性脑卒中合并重症肺炎患者病原菌分布与T细胞亚群改变及预后  

Pathogenic bacteria distribution,changes in T-cell subsets and prognosis in elderly patients with acute ischemic stroke complicated with severe pneumonia

作　　者：于蕾[1] 姜薇薇[1] 李吉明[1] Yu Lei;Jiang Weiwei;Li Jiming(Intensive Care Unit at Emergency Center,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院急救中心重症监护室,乌鲁木齐830000

出　　处：《中华老年多器官疾病杂志》2024年第9期655-658,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：新疆维吾尔自治区自然科学基金(2021D01C455)。

摘　　要：目的研究老年急性缺血性脑卒中合并重症肺炎(SP)者病原菌分布特点、T淋巴亚群改变及预后分析。方法将2021年3月至2023年3月新疆医科大学第一附属医院急救中心收治的150例老年急性缺血性脑卒中合并肺炎患者纳为研究对象,根据肺炎严重程度将其分为SP组与非SP(NSP)组,统计其临床资料、病原菌培养与药敏试验结果、外周血T淋巴细胞亚群占比以及患者28 d死亡率。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。结果SP组患者平均年龄、美国国立卫生研究院卒中量表(NIHSS)评分、慢性阻塞性肺疾病(COPD)患病率、意识障碍发生率均高于NSP组,差异均有统计学意义(均P<0.05);两组卒中部位比较,差异有统计学意义(P<0.05)。70例SP患者中共培养出病原菌68株,其中革兰阴性菌占比88.24%(60/68),革兰阳性菌占比11.76%(8/68);检出率最高的三种病原菌分别为鲍氏不动杆菌(47.06%,32/68)、铜绿假单胞菌(14.71%,10/68)及肺炎雷克伯菌(13.24%,9/68)。鲍曼不动杆菌对复方新诺明及头孢哌酮/舒巴坦相对敏感。铜绿假单胞菌对妥布霉素及阿米卡星的灵敏性较高,对庆大霉素及喹诺酮类抗菌素相对灵敏,肺炎克雷伯菌对阿米卡星及亚胺培南的灵敏性最高。SP组患者CD3^(+)、CD4^(+)以及CD4^(+)/CD8^(+)水平低于存活组,CD8^(+)高于NSP组,差异均有统计学意义(均P<0.05)。SP组28 d死亡率为45.71%(32/70),高于NSP组的6.25%(5/80)(χ^(2)=31.290;P<0.05)。死亡者CD3^(+)、CD4^(+)以及CD4^(+)/CD8^(+)水平低于存活组,CD8^(+)高于存活者,差异均有统计学意义(P<0.05)。结论缺血性脑卒中合并SP将增加患者死亡风险,年龄、NIHSS评分、合并CODP及意识障碍可能是促进缺血性脑卒中一般肺炎向SP发展的相关因素,且免疫失衡还可能参与缺血性脑卒中SP发生相关机制,并增加患者死亡风险。Objective To investigate the distribution characteristics of pathogenic bacteria,changes in the T-lymphocyte(T-cell)subsets and prognosis in the elderly patients with acute ischemic stroke complicated with severe pneumonia(SP).Methods A total of 150 elderly patients with acute ischemic stroke complicated with pneumonia at the Emergency Center of the First Affiliated Hospital of Xinjiang Medical University from March 2021 to March 2023 were enrolled as the study subjects.According to the severity of pneumonia,the patients were divided into the SP group and the non-SP(NSP)group.Clinical data,pathogenic bacteria culture and drug sensitivity test results,proportions of T-cell subsets in peripheral blood and 28-d mortality rate of patients were collected.SPSS 22.0 was used for statistical analysis.Data comparison between two groups was performed using t test orχ^(2) test depending on data type.Results The mean age,National Institutes of Health Stroke Scale(NIHSS)score,prevalence of chronic obstructive pulmonary disease(COPD)and incidence of consciousness disorder in the SP group were higher than those in the NSP group,and the differences were statistically significant(P<0.05).The difference in the stroke site between the two groups was statistically significant(P<0.05).In 70 SP patients,68 strains of pathogenic bacteria were cultured,including 60(88.24%)Gram-negative bacteria and 8(11.76%)Gram-positive bacteria.The three pathogenic bacteria with the top three detection rates were Acinetobacter baumannii(47.06%,32/68),Pseudomonas aeruginosa(14.71%,10/68)and Klebsiella pneumoniae(13.24%,9/68).Acinetobacter baumannii was relatively sensitive to cotrimoxazole and cefoperazone/sulbactam.Pseudomonas aeruginosa was highly sensitive to tobramycin and amikacin and relatively sensitive to gentamicin and quinolones.Klebsiella pneumoniae was most sensitive to amikacin and imipenem.The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the SP group were lower than those in the NSP group,and the CD8^(+)was higher than that in NSP grou

关 键 词：老年人 重症肺炎 病原菌 T淋巴亚群 预后分析 

分 类 号：R563.1[医药卫生—呼吸系统]