T淋巴细胞亚群及营养状态对老年重型颅脑损伤患者预后的影响  

Effect of T lymphocyte subsets and nutritional status on prognosis in elderly patients with severe craniocerebral injury

作　　者：王悦蒙 于琴 Wang Yuemeng;Yu Qin(Intensive Care Unit,Affiliated Dazu′s Hospital of Chongqing Medical University,Chongqing 402360,China)

机构地区：[1]重庆医科大学附属大足医院重症医学科,重庆402360

出　　处：《中华老年多器官疾病杂志》2025年第4期291-295,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：重庆市大足区科技发展项目(DZKI2023-JSYJ-KWXM1036)。

摘　　要：目的探讨T淋巴细胞亚群及营养状态对老年重型颅脑损伤患者预后的影响。方法回顾性分析2022年5月至2023年12月重庆医科大学附属大足医院收治的109例老年重型颅脑损伤患者的临床资料,根据患者出院3个月后的格拉斯哥预后评分(GOS)情况将患者分为预后良好组(n=56)与预后不良组(n=53)。比较两组患者一般资料、T淋巴细胞亚群及营养状态[营养风险筛查量表2002(NRS2002)评分和血清白蛋白(ALB)水平]。采用SPSS 26.0统计软件进行数据处理。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用多因素logistic回归模型分析老年重型颅脑损伤患者预后的影响因素。结果预后不良组T淋巴细胞亚群CD4^(+)、CD4^(+)/CD8^(+)水平均低于预后良好组,CD8^(+)水平高于预后良好组;预后不良组NRS2002评分≥3分比例高于预后良好组,且NRS2002评分高于预后良好组,ALB水平低于预后良好组,差异均有统计学意义(P<0.05);预后不良组入院格拉斯哥昏迷评分(GCS)低于预后良好组,颅内血肿量、入院血糖、入院收缩压(SBP)及入院舒张压(DBP)高于预后良好组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,CD4^(+)/CD8^(+)(OR=2.849,95%CI 1.329~6.107)、NRS2002评分(OR=0.312,95%CI 0.131~0.742)、ALB水平(OR=3.959,95%CI 1.434~10.927)、入院GCS评分(OR=3.607,95%CI 1.538~8.462)、颅内血肿量(OR=0.330,95%CI 0.150~0.724)、入院血糖(OR=0.370,95%CI 0.177~0.774)及入院SBP(OR=0.298,95%CI 0.132~0.673)是老年重型颅脑损伤患者预后的影响因素(P<0.05)。结论T淋巴细胞亚群及营养状态是影响老年重型颅脑损伤患者预后的因素,增强患者免疫功能,增强其营养状态或可改善患者预后。Objective To investigate the effects of T lymphocyte subsets and nutritional status on the prognosis of elderly patients after severe craniocerebral injury.Methods The clinical data of 109 elderly patients with severe craniocerebral injury admitted to our hospital between May 2022 to December 2023 were retrospectively collected and analyzed.According to the Glasgow outcome scale(GOS)in three months after discharge,they were divided into good prognosis group(n=56)and poor prognosis group(n=53).The clinical data were compared between the two groups,including basic data,T lymphocyte subsets and nutritional status[nutritional risk screening 2002(NRS2002)score and serum albumin(ALB)levels].SPSS statistics 26.0 was used for statistical analysis,and t test orχ^(2) test was employed for intergroup comparison depending on data type.Multivariate logistic regression analysis was utilized to identify the factors affecting the prognosis of these elderly patients.Results The poor prognosis group had significantly smaller percentage of CD4^(+)T lymphocytes but larger percentage of CD8^(+)T cells,and lower CD4^(+)/CD8^(+)level than the good prognosis group(all P<0.05).Obviously larger ratio of the patients with NRS2002 score≥3 points,higher NRS2002 score,and lower ALB level were observed in the poor prognosis group when compared with the good prognosis group(all P<0.05).The Glasgow coma scale(GCS)was notably lower,and the intracranial hematoma,blood glucose level,systolic blood pressure(SBP)and diastolic blood pressure(DBP)at admission were markedly higher in the poor prognosis group than the good prognosis group(all P<0.05).Multivariate logistic regression analysis showed that CD4^(+)/CD8^(+)(OR=2.849,95%CI 1.329-6.107),NRS2002 score(OR=0.312,95%CI 0.131-0.742),ALB level(OR=3.959,95%CI 1.434-10.927),baseline GCS score(OR=3.607,95%CI 1.538-8.462),intracranial hematoma(OR=0.330,95%CI 0.150-0.724),baseline blood glucose(OR=0.370,95%CI 0.177-0.774)and SBP at admission(OR=0.298,95%CI 0. 132 - 0. 673) were influencing factors for

关 键 词：老年人 重型颅脑损伤 T淋巴细胞亚群 营养状态 

分 类 号：R592[医药卫生—老年医学] R651.15[医药卫生—内科学]