重症监护病房医院获得性感染患者免疫功能的临床特点

发布时间：2018-07-05 17:26

  本文选题：医院获得性感染 + 社区获得性肺炎　； 参考：《中国呼吸与危重监护杂志》2016年01期

【摘要】：目的探讨重症监护病房(ICU)内医院获得性感染的影响因素以及CD3~+CD4~+T细胞对医院感染的预测价值。方法选择2014年3月至2014年12月在上海市闵行区中心医院ICU及呼吸内科住院的111例住院患者。其中社区获得性肺炎患者33例为社区获得性肺炎组(CAP组),入住ICU而未发生医院获得性感染的患者31例为无医院获得性感染组(NNI组),入住ICU并发生医院获得性肺炎的患者47例为医院获得性肺炎组(HAP组)。比较三组患者T淋巴细胞、B淋巴细胞及CD3~+CD4~+、CD3~+CD8~+、NK细胞计数等指标,观察CD3~+CD4~+T细胞对医院感染的预测作用。结果三组患者性别、年龄等指标差异无统计学意义(P0.05),APACHEⅡ评分差异有统计学意义(P=0.025)。与其他两组比较,HAP组患者CD3~+CD4~+T淋巴细胞计数减少(P=0.005)。绘制受试者工作特征(ROC)曲线,CD3~+CD4~+T淋巴细胞计数预测HAP的ROC曲线下面积(AUC)为0.660,阈值为29.96%,敏感性93.8%特异性40.4%。三组患者T淋巴细胞百分比(P=0.001)、B淋巴细胞计数(P=0.021)差异有统计学意义,CD3~+CD8~+淋巴细胞、NK细胞、CD3~+CD4~+/CD3~+CD8~+T淋巴细胞比较差异无统计学意义(P0.05)。三组患者C4水平有显著差异(P=0.003),C3水平无显著差异(P0.05),IgG、IgM、IgA、IgE无显著差异(P0.05)。三组患者白细胞及中性粒细胞计数、降钙素原、C反应蛋白比较差异无统计学意义(P0.05)。结论 CD3~+CD4~+T细胞可以作为一个医院感染的独立预测因素,对临床工作具有指导意义。
[Abstract]:Objective to investigate the influencing factors of nosocomial infection in intensive care unit (ICU) and the predictive value of CD3 ~ CD4 ~ T cells in nosocomial infection. Methods 111 inpatients from ICU and Department of Respiratory Medicine in Shanghai Minhang District Central Hospital from March 2014 to December 2014 were selected. Among them, 33 patients with community-acquired pneumonia (CAP group) and 31 patients without nosocomial infection (NNI group) were admitted to ICU with nosocomial pneumonia. Forty-seven patients were treated with nosocomial pneumonia (HAP). To compare the counts of T lymphocyte B lymphocytes and CD3 ~ CD4 ~ + CD3 ~ CD8 ~ + NK cells in three groups, and to observe the predictive effect of CD3 ~ CD4 ~ T cells on nosocomial infection. Results there was no significant difference in sex, age and other indexes among the three groups (P0.05). There was significant difference in Apache 鈪，

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