鲍曼不动杆菌医院获得性肺炎患者的免疫功能及预后分析

发布时间：2018-04-10 09:32

本文选题：多重耐药鲍曼不动杆菌　切入点：医院获得性肺炎　出处：《广西医科大学》2017年硕士论文

【摘要】：目的探讨重症监护病房中多重耐药鲍曼不动杆菌(MDRAB)医院获得性肺炎(HAP)患者的免疫功能,各免疫指标对医院感染的预测价值及对预后的影响,以更好地指导临床工作,降低患者的病死率。方法采用病例对照的研究方法,回顾性分析2011年6月一2016年6月广西医科大学第一附属医院MDRAB HAP 87例为观察组,并选取同时期非MDRAB HAP 62例作为对照组,比较两组患者T淋巴细胞、免疫球蛋白、NK细胞计数等免疫指标及降钙素原、C反应蛋白、白细胞等炎性指标,观察各免疫指标及炎性指标对医院感染的预测作用。应用t检验进行比较两组中各免疫指标及炎性指标有无差异;将87例MDRAB HAP患者分为死亡组24例和存活组63例,应用Logistic回归分析MDRAB HAP死亡的预后因素。应用ROC曲线评估各有统计学意义的指标对医院感染的预测价值。结果观察组和对照组两组患者性别、年龄等指标无统计学意义(P0.05),APACHE II评分差异有统计学意义(P0.05)。对于免疫指标,两组总T细胞、CD8+T淋巴细胞、免疫球蛋白M、免疫球蛋白G、NK细胞的比较,差异均无统计学意义(均P0.05),但两组中CD4+T淋巴细胞、免疫球蛋白A的比较,差异均有统计学意义(均P0.05),绘制CD4+T淋巴细胞和免疫球蛋白A预测HAP的ROC曲线均具有较大诊断价值;炎性指标的研究中,患者白细胞计数、中性粒细胞百分比、降钙素原、C反应蛋白的比较,差异均无统计学意义(均P0.05)。针对CD4+T细胞、免疫球蛋白A绘制ROC曲线,其中CD4+T细胞的AUC值为0.608,敏感度为62.7%、特异度为57.5%;免疫球蛋白A的AUC值为0.637,敏感度为58.7%、特异度为76.4%,均有较大的预测价值。结论免疫指标CD4+T细胞、免疫球蛋白A、APACHE II评分对指导重症监护病房中HAP患者的临床治疗有重要价值,对多重耐药鲍曼不动杆菌(MDRAB)医院获得性肺炎(HAP)患者的免疫功能及其预后的评估有具有重要意义。
[Abstract]:Objective to investigate the immune function of patients with multidrug resistant Acinetobacter baumannii (MDRAB) hospital acquired pneumonia (HAP) in intensive care unit (ICU), the predictive value of each immune index to nosocomial infection and its influence on prognosis, so as to guide the clinical work better.Reduce the mortality of patients.Methods A case-control study was conducted to retrospectively analyze 87 cases of MDRAB HAP in the first affiliated Hospital of Guangxi Medical University from June 2011 to June 2016, and 62 cases of non-#en2# HAP in the same period as control group.The immune indexes such as T lymphocyte, immunoglobulin NK cell count, procalcitonin C reactive protein, white blood cell and so on were compared between the two groups, and the predictive effect of each immune index and inflammatory index on nosocomial infection was observed.87 patients with MDRAB HAP were divided into death group (n = 24) and survival group (n = 63). Logistic regression analysis was used to analyze the prognostic factors of MDRAB HAP death.ROC curve was used to evaluate the predictive value of statistically significant indexes for nosocomial infection.Results there was no significant difference in gender, age and other indexes between the observation group and the control group. There was significant difference in Apache II score between the two groups (P 0.05).There was no significant difference in total T cell CD8 T lymphocytes, immunoglobulin M and immunoglobulin Gnk NK cells between the two groups (all P 0.05), but the comparison of CD4 T lymphocytes and immunoglobulin A between the two groups.The difference was statistically significant (all P0.05A, CD4 T lymphocytes and immunoglobulin A were used to predict the ROC curve of HAP.The difference of procalcitonin C-reactive protein was not statistically significant (P 0.05).The ROC curve of immunoglobulin A was drawn for CD4 T cells. The AUC value, sensitivity and specificity of CD4 T cells were 0.608, 62.7and 57.5, respectively, and the AUC value, sensitivity and specificity of immunoglobulin A were 0.637, 58.7 and 76.4, respectively.Conclusion the CD4 T cell and immunoglobulin A Apache II score have important value in guiding the clinical treatment of HAP patients in intensive care unit.It is of great significance to evaluate the immune function and prognosis of patients with multidrug resistant Acinetobacter baumannii MDRAB (Hospital acquired pneumonia).
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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