外周血淋巴细胞计数与社区获得性肺炎严重程度的关系研究

发布时间：2018-05-27 22:08

本文选题：淋巴细胞绝对计数 + 社区获得性肺炎　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:外周血淋巴细胞绝对计数(Absolute Lymphocyte Count,ALC)被认为是能够反映脓毒症疾病严重程度以及预测预后的指标,本文研究社区获得性肺炎(Community Acquired Pneumonia,CAP)患者ALC与病情严重程度的关系,评价ALC对社区获得性肺炎预后的预测价值。方法:选择2016年3月-2017年2月入住福建中医药大学附属人民医院呼吸内科及ICU的社区获得性肺炎患者为CAP组,CAP组按肺炎严重指数(PSI)将患者分为低危组、中危组、高危组,收集CAP组的临床资料,检测入院ALC和T淋巴细胞亚群水平,记录治疗转归情况。同期选择门诊健康体检者作为对照组,检测对照组的ALC及T淋巴细胞亚群水平。结果:(1)ALC及T淋巴细胞水平:CAP组ALC明显低于正常对照组(M(IQR):1.10(0.80,1.50)×109/Lvs 1.80(1.40,2.1)×109/L,p0.05),CAP 组 CD3+、CD4+、CD8+绝对值明显低于正常对照组,差异有统计学意义(p0.05)。(2)CAP组间低、中、高危组间ALC及T淋巴细胞水平:CAP低、中、高危组ALC水平有差异(M(IQR):1.40(1.02,1.87)×109/L、1.00(0.60,1.32)×109/L、0.80(0.40,1.20)×109/L,p0.05),高危组CD3+、CD4+、CD8+绝对值低于低、中危组,中危组CD3+、CD4+、CD8+绝对值低于低危组,各组两两比较差异有统计学意义(p0.05)。(3)CAP不同风险组治疗转归情况比较:低、中、高危组初始治疗失败率分别为5.76%、16.67%、45.16%,组间比较差异均有统计学意义(p0.05)。低、中、高危组死亡率分别为0%、10.00%、35.48%,两两比较差异有统计学意义(p0.05)。(4)ALC与疾病严重程度的相关性:ALC水平与肺炎严重程度(PSI评分)呈负相关性(r=*0.692,p0.05)。(5)ALC对CAP患者死亡的预测价值:ALC预测CAP死亡的ROC分析,曲线下面积为 0.721(95%CI,0.541-0.901),ALC 的截断值取 0.65×109/L,敏感性为 59%,特异性为86%。结论:CAP患者ALC水平与病情严重程度(PSI)呈负相关,ALC能反映CAP患者的细胞免疫功能,对CAP的预后的有预测价值。故在CAP的诊治过程中,尤其是无法开展淋巴细胞亚群的基层医院,可以通过血常规中淋巴细胞水平结合PSI评分表评估患者病情严重程度,预测疾病预后,节约检验成本。
[Abstract]:Objective: absolute count of peripheral blood lymphocytes (absolute Lymphocyte count) is considered to be a predictor of the severity and prognosis of sepsis. The relationship between ALC and severity of the disease in patients with community acquired pneumonia (CPAP) was studied. To evaluate the prognostic value of ALC in community acquired pneumonia. Methods: patients with community-acquired pneumonia who were admitted to Department of Respiratory Medicine and ICU in Renmin Hospital affiliated to Fujian University of traditional Chinese Medicine from March 2016 to February 2017 were divided into low risk group, moderate risk group and high risk group according to the severity index of pneumonia in CAP group. The clinical data of CAP group were collected, the ALC and T lymphocyte subsets were detected and the outcome of treatment was recorded. The ALC and T lymphocyte subsets of the control group were measured. Results the absolute values of ALC and T lymphocytes in the ALC group were significantly lower than those in the control group (P < 0.05). The absolute value of CD3 CD 4 and CD 8 in the 109/Lvs group was significantly lower than that in the control group. The levels of ALC and T lymphocytes in the high risk group were significantly lower than those in the control group. The levels of ALC and T lymphocytes in the high risk group were lower than those in the normal control group, and the levels of ALC and T lymphocyte in the high risk group were lower than those in the control group, and the levels of ALC and T lymphocyte in the high risk group were significantly lower than those in the normal control group. There was a difference in the ALC level of high risk group (1.40 / 1. 02 / 1.87) 脳 10 ~ 9 / L / L 1.00 0.60 / 1.32) 脳 10 ~ 9 / L ~ (0.80) 0.40 ~ (1.20) 脳 10 ~ 9 / L P ~ (0.05). The absolute value of CD3 / CD _ 4 / CD _ 8 in high risk group was lower than that in high risk group, and the absolute value of CD _ 4 / CD _ 8 in middle risk group was lower than that in low risk group. There was a significant difference between the two groups in the outcome of treatment in different risk groups: low and moderate. The failure rate of initial treatment in high risk group was 5.76% and 16.67% and 45.16%, respectively. The difference between the two groups was statistically significant (P 0.05). Low, medium, The mortality rate of high risk group was 10.00 and 35.48 respectively. There was a significant correlation between the two groups. There was a negative correlation between the level of CAP and the severity of pneumonia (P < 0.05). ROC analysis was used to predict the death of CAP in patients with CAP. The area under the curve of 0.541-0.901C was 0.541-0.901.The truncation value of ALC was 0.65 脳 10 ~ 9 / L, the sensitivity was 59g and the specificity was 86.1% 路L ~ (-1). Conclusion there is a negative correlation between the level of ALC and the severity of the disease in patients with CAP. ALC can reflect the cellular immune function of patients with CAP, and it is valuable to predict the prognosis of CAP. Therefore, in the diagnosis and treatment of CAP, especially in the basic hospitals where lymphocyte subsets can not be developed, the severity of the disease can be evaluated by the level of lymphocytes in blood routine combined with the PSI scoring table, the prognosis of the disease can be predicted, and the cost of examination can be saved.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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