老年社区获得性肺炎患者呼吸支持治疗期间外周血淋巴细胞计数的动态变化及意义

Dynamic changes and significance of peripheral blood lymphocyte counts during respiratory support therapy in elderly patients with community-acquired pneumonia

目的:探究老年社区获得性肺炎(CAP)患者采取呼吸支持治疗的临床效果。方法:回顾性分析122例接受呼吸支持治疗的老年CAP患者临床资料,根据治疗3d后CAP严重程度CURB-65量表评分情况,分为观察组(CURB-65≤2分,n=76)与对照组(CURB-65>2分,n=46)。比较两组治疗前及治疗3h、9h、24h时,两组外周血T淋巴细胞表面分化抗原计数(CD3+、CD4+、CD8+)、白细胞计数(WBC)、中性粒细胞/淋巴细胞计数比(NLR)及血清炎症因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)]水平变化。结果:治疗3h后,观察组外周血CD3+、CD4+、CD8+水平均较治疗前有显著提升,且明显高于对照组;观察组外周血WBC、NLR及血清CRP、IL-6、PCT水平均较治疗前有显著下降,且明显低于对照组。治疗9h、24h时,两组外周血CD3+、CD4+、CD8+水平均较治疗前有显著提升,且观察组明显高于同期对照组;两组外周血WBC、NLR及血清CRP、IL-6、PCT水平均较治疗前有显著下降,且观察组明显低于同期对照组。结论:老年CAP患者采取呼吸支持治疗期间外周血淋巴细胞计数增幅较大可提示为预后良好,在治疗效果评估方面有一定临床应用价值。

Objective To explore the clinical effects of respiratory support therapy in elderly patients with community-acquired pneumonia(CAP).Methods The clinical data of 122 elderly patients with CAP who underwent respiratory support therapy were retrospectively analyzed.According to the CURB-65 score of CAP severity after 3 d of treatment,the patients were divided into observation group(CURB-65≤2 points,n=76)and control group(CURB-65>2 points,n=46).The surface differentiation antigen counts(CD3+,CD4+,CD8+),white blood cell count(WBC)and neutrophil/lymphocyte count ratio(NLR)of peripheral blood T lymphocytes and serum inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT)]were compared between the two groups before treatment and at 3h,9h,and 24h of treatment.Results After 3 h of treatment,the levels of CD3+,CD4+and CD8+in peripheral blood in observation group were significantly higher than those before treatment.The levels of peripheral blood WBC and NLR and serum CRP,IL-6 and PCT in observation group were significantly decreased compared with those before treatment,and were significantly lower than those in control group.At 9h and 24h of treatment,the levels of CD3+,CD4+and CD8+in peripheral blood in the two groups were significantly higher than those before treatment,and the levels in observation group were significantly higher than those in control group.The levels of peripheral blood WBC and NLR and serum CRP,IL-6 and PCT in the two groups were significantly lower than those before treatment,and the levels in observation group were significantly lower than those in control group.Conclusions The increase of peripheral blood lymphocyte counts in elderly patients with CAP during respiratory support therapy may indicate a good prognosis and it has certain clinical application value in the evaluation of treatment effects.