重症细菌性肺炎患者T淋巴细胞亚群的临床研究

发布时间：2018-04-21 12:23

本文选题：T淋巴细胞亚群 + 流式细胞术　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:通过综合分析肺泡灌洗液(Bronchoalveolar lavage fluid BALF)及外周血T淋巴细胞亚群,旨在探讨重症细菌性肺炎患者肺组织局部及整体的免疫状态,并联合PCT、PSI评分探讨外周血T细胞亚群对于预测重症肺炎的临床价值。方法:收集2016年10月至2017年1月于天津医科大学总医院呼吸内科住院治疗并诊断为社区获得性细菌性肺炎患者63例,依诊断标准分为重症肺炎(Severe pneumonia SP)组和非重症肺炎(NSP)组,依PSI评分分为低危组、中危组、高危组三组。检测外周血T细胞亚群、PCT、血常规,BALF T细胞亚群、细胞分类。比较SP组与NSP组BALF与外周血T细胞各亚群水平、临床特征差异。比较低危、中危、高危三组外周血T细胞各亚群水平、PCT、WBC水平;分析上述各指标与PSI评分之间的相关性及T细胞亚群对SP的预测能力。结果:本研究共纳入细菌性肺炎患者63例,SP组17例,NSP组46例,两组患者BALF T细胞亚群:SP组CD4+百分比、CD4+/CD8+小于NSP组,CD8+百分比大于NSP组,以上均无统计学差异;中性粒细胞(Neutrophil Neu)百分比SP组大于NSP组,差异具有统计学意义。两组外周血T细胞亚群:SP组CD3+、CD4+百分比小于NSP组,CD8+百分比、CD4+/CD8+大于NSP组,以上均无统计学差异;SP组CD3+、CD4+、CD8+绝对值均小于NSP组,差异具有统计学意义。SP组患者年龄、PCT、WBC、PSI评分、肿瘤、心脏疾病、脑梗、肝病所占比例均明显高于NSP组,而吸烟史、COPD、糖尿病、检出菌株构成比两组间无统计学差异。低危组、中危组、高危组三组患者CD3+、CD4+、CD8+绝对值均随PSI评分严重程度的升高而降低,以上均具有统计学意义;CD3+、CD4+、CD8+百分比、CD4+/CD8+比值均无统计学差异。比较CD3+、CD4+、CD8+绝对值、PCT与PSI评分相关性:低危组上述指标与PSI评分均无明显相关;中危组中上述指标与PSI评分均呈明显负相关;高危组上述指标与PSI评分相关性更强;其中,中高危组CD3+绝对值相关性甚至高于PCT。以CD3+绝对值预测SCAP准确性可达中等水平(AUC=0.895 P0.0001),以0.46为标准,敏感性88.24%,特异性89.13%,仅次于PSI评分(AUC=0.955 P0.0001)。结论:SP患者肺组织局部以及整体的免疫状态可能都存在一定程度的紊乱。年龄、肿瘤、心脏疾病、脑梗、肝病可能是造成其免疫功能低下的重要因素,而SP患者过度的炎症反应可能也是造成淋巴细胞减少的原因。外周血T淋巴细胞亚群可能可以用于SP的预测,且百分比应用价值不及绝对值。
[Abstract]:Objective: to investigate the local and global immune status of lung tissue in patients with severe bacterial pneumonia by comprehensive analysis of bronchoalveolar lavage fluid BALFs and T lymphocyte subsets in peripheral blood of patients with severe bacterial pneumonia. The clinical value of peripheral blood T cell subsets in predicting severe pneumonia was also discussed in combination with PCT PSI score. Methods: from October 2016 to January 2017, 63 patients with community-acquired bacterial pneumonia were treated in Department of Respiratory Medicine, Tianjin Medical University General Hospital. According to the diagnostic criteria, 63 patients were divided into severe pneumonia pneumonia group and non-severe pneumonia group. According to PSI score, they were divided into three groups: low risk group, middle risk group and high risk group. The peripheral blood T cell subsets (PCT), BALF T cell subsets (BALF T cell subsets) and cell classification were detected. The levels and clinical characteristics of T cell subsets of BALF and peripheral blood in SP group and NSP group were compared. The level of peripheral blood T cell subsets and the correlation between the above indexes and PSI score and the prediction ability of T cell subsets to SP were analyzed. Results: a total of 63 patients with bacterial pneumonia were included in this study. There were 46 cases of BALF T cell subgroup (BALF T cell subsets) in 17 cases of NSP group. The percentage of CD4 CD4 / CD8 in the group of BALF T cell subsets was lower than that in group NSP (P < 0.01), and the percentage of CD8 in group C was higher than that in group NSP (P < 0.05). The percentage of neutrophil neutrophil in SP group was higher than that in NSP group. The percentage of CD4 / CD8 of peripheral blood T cell subsets in the two groups was lower than that in the NSP group. The ratio of CD4 / CD8 was higher than that in the NSP group. There was no statistical difference between the two groups. The absolute value of CD3 CD 4 / CD 8 in SP group was lower than that in NSP group. The difference was statistically significant. The age of the patients in SP group was significantly lower than that in the control group (P < 0.05). The proportion of heart disease, cerebral infarction and liver disease was significantly higher than that of NSP group, but there was no statistical difference between the two groups in smoking history and diabetes mellitus. The absolute value of CD3 CD4 / CD8 decreased with the increase of PSI score in low risk group, middle risk group and high risk group. There was no significant difference in the percentage of CD 4 / CD 8 and the ratio of CD 4 / CD 8. Comparing the absolute value of CD3 and CD 4, CD 8 and PSI score, the above indexes were not significantly correlated with PSI score in low risk group, the above indexes were negatively correlated with PSI score in middle risk group, the correlation between above indexes and PSI score was stronger in high risk group, among them, there was no significant correlation between above indexes and PSI score in low risk group, and there was significant correlation between above indexes and PSI score in high risk group. The absolute value correlation of CD3 in middle and high risk group was even higher than that in PCT. The accuracy of predicting SCAP by absolute value of CD3 was 0.895 P0.0001, and the sensitivity was 88.24 and the specificity was 89.13, second only to the PSI score of 0.955 P0.0001. The accuracy of predicting SCAP was 0.895 P0.0001, and the sensitivity was 88.24%, and the specificity was 89.13%, second only to that of PSI score (0.955 P0.0001). Conclusion there may be some disorder in the immune state of the lung tissue in patients with 1% SP. Age, tumor, heart disease, cerebral infarction, liver disease may be the important factors of low immune function, and the excessive inflammatory reaction in SP patients may also be the cause of lymphocytopenia. The T lymphocyte subsets in peripheral blood may be used to predict SP, and the application value of percentage is lower than that of absolute value.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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