卒中相关性肺炎病原菌分布特征及其与免疫系统功能变化的关系

发布时间：2018-02-15 15:18

本文关键词： 卒中相关性肺炎 T淋巴细胞亚群免疫抑制病原菌　出处：《中国病原生物学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的分析卒中相关性肺炎(SAP)患者病原菌分布特征和T淋巴细胞亚群变化,探讨其与细胞免疫功能的关系。方法选择2014年12月至2016年9月在本院重症监护病房(ICU)住院治疗的急性脑卒中患者95例。患者入院后即进行NIHSS评分,根据评分将入选患者分为重症组(57例)和轻症组(38例);根据入院后1~2周内是否发生感染将患者分为SAP组(53例)和非SAP组(42例);选择同期在本院体检中心体检的健康者40例作为对照组。根据痰培养结果分析SAP患者病原菌分布特征;检测并比较各组受检者T淋巴细胞亚群(CD3~+、CD4~+、CD4~+/CD8~+)变化,分析其与NIHSS评分的相关性。结果 SAP组NIHSS评分(15.3±5.4)分,与非SAP组(8.8±3.2)比较差异有统计学意义(P0.05)。53例SAP患者共分离出病原菌81株,其中鲍曼不动杆菌15株(18.5%),肺炎克雷伯菌12株(14.8%),金黄色葡萄球菌26株(32.1%),铜绿假单胞菌9株(11.1%),大肠埃希菌7株(8.6%),粪、屎肠球菌5株(6.2%),肺炎链球菌5株(6.2%),真菌2株(2.5%)。卒中患者CD3~+、CD4~+T淋巴细胞百分率及CD4~+/CD8~+比值均显著低于对照组(P0.05),其中重症组CD3+(61.20±5.29)%、CD4+(27.66±4.59)%、CD4~+/CD8~+值为0.91±0.46,轻症组分别为(66.61±4.98)%、(33.70±4.95)%和1.23±0.57,差异均有统计学意义(P0.05);SAP组CD3~+(62.24±4.87)%、CD4~+(30.59±5.26)%,CD4~+/CD8~+值为0.98±0.45,与非SAP组(64.64±4.49)%、(33.13±4.90)%和1.21±0.53比较差异均有统计学意义(P0.05);CD3~+、CD4~+T淋巴细胞百分率及CD4~+/CD8~+值均与NIHSS评分呈显著负相关(r分别为-0.382、-0.521、-0.291,P_均0.05)。结论 SAP患者感染主要病原菌为革兰阴性菌,SAP的发生与卒中患者细胞免疫功能受抑制有关,且卒中病情越重,患者细胞免疫功能抑制越严重。
[Abstract]:Objective to analyze the distribution of pathogenic bacteria and the changes of T lymphocyte subsets in patients with stroke associated pneumonia (SAP). Methods from December 2014 to September 2016, 95 patients with acute stroke were treated in intensive care unit (ICU) of our hospital. The patients were assessed with NIHSS score immediately after admission. According to the score, the patients were divided into severe group (n = 57) and mild group (n = 38); according to whether infection occurred within 1 to 2 weeks after admission, the patients were divided into SAP group (n = 53) and non-#en1# group (n = 42). According to the results of sputum culture, the distribution characteristics of pathogenic bacteria in patients with SAP were analyzed. The changes of T lymphocyte subsets (CD3 ~ + CD4 ~ + CD4 ~ / CD8 ~) and their correlation with NIHSS score were detected and compared. Results the NIHSS score of SAP group was 15. 3 卤5. 4%. 81 strains of pathogenic bacteria were isolated from 53 patients with SAP, compared with the control group (8.8 卤3.2). Among them, Acinetobacter baumannii (15 strains), Klebsiella pneumoniae (12 strains), Staphylococcus aureus (26 strains), Pseudomonas aeruginosa (9 strains), Escherichia coli (7 strains), Escherichia coli (8. 6%), feces, Five strains of Enterococcus faecium, 5 strains of Streptococcus pneumoniae, 5 strains of Streptococcus pneumoniae, 2 strains of fungi and 2 strains of fungi showed that the percentage of CD4 ~ T lymphocytes and the ratio of CD4 ~ / -CD8 ~ ~ of CD4 ~% in stroke patients were significantly lower than those in the control group (P < 0.05). The CD8~ values of severe group were 61.20 卤5.29 and 0.91 卤0.46, respectively, and those of mild group were 33.70 卤4.95% and 1.23 卤0.57, respectively, and the difference was 0.91 卤0.46, and that of mild group was 66.61 卤4.983.70 卤4.95% and 1.23 卤0.57 respectively, and that of severe group was 0.91 卤0.46, that of severe group was 66.61 卤4.985.95% and 1.23 卤0.57, respectively. There were significant differences in CD3 ~ T lymphocyte percentage and CD4- + -CD8- T lymphocyte percentage and CD4- + -CD8- T lymphocyte percentage and CD4- + -CD8- value between P0.05 and SAP group (P 0.05, P < 0. 05 卤4. 26, P < 0. 05, r = 0. 382- 0. 521, P = 0. 05 and 0. 021 卤0. 53, P < 0. 05 and P < 0. 05). Conclusion: the percentage of CD4 ~ T lymphocyte and the value of CD4 ~-CD8 ~ ~ in SAP group are negatively correlated with NIHSS score, respectively (r = -0. 382- 0. 521-0. 291P _ 0. 05) and 0. 05 卤0. 05 卤0. 05 卤0. 05%, respectively. Conclusion there is a significant negative correlation between the percentage of CD4 ~ T lymphocytes and the value of CD4 ~ +-CD8 ~ + in SAP group. The main pathogen of SAP infection was Gram-negative bacteria. The occurrence of SAP was related to the inhibition of cellular immune function in patients with stroke. The more severe the stroke, the more serious the inhibition of cellular immune function.
【作者单位】：郑州大学附属郑州中心医院重症监护室;
【分类号】：R743.3;R563.1

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