慢性阻塞性肺部疾病急性加重细胞和体液免疫状态与评价

Observation and evaluation on cellular and humoral immunity for patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺部疾病急性加重（AECOPD）患者细胞、体液免疫状态及其与急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分的关系。方法前瞻性收集AECOPD患者临床资料与入科24小时和入科第7天外周血标本，流式细胞仪检测细胞免疫指标-T淋巴细胞亚群（CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋），免疫散射比浊法检测体液免疫指标（IgG、IgA、IgM）；依据APACHEⅡ评分分组，比较其与细胞、体液免疫指标相关性。结果75例AECOPD患者，男37例，女38例，平均年龄（76．4±9．8）岁，APACHEⅡ评分（22．77±5．27）分；APACHEⅡ评分≤21分组37例，男19例，女18例，平均年龄（75．08±10．42）岁，APACHEⅡ评分（18．43±1．86）分；〉21分组38例，男18例，女20例，平均年龄（78．21±8．66）岁，APACHEⅡ评分为（27．08±3．96）分；两组患者入科24小时与入科第7天细胞、体液免疫指标比较差异无统计学意义（P〉0．05），≤21分组入科24小时与入科第7天各项指标比较差异均无统计学意义（P〉0．05），〉21分组人科24小时CD4^＋／CD8^＋、IgG低于入科第7天（P〈0．05）；所有患者细胞、体液免疫指标与APACHEⅡ无显著相关性（P〉0．05）。结论AECOPD患者存在不同程度细胞、体液免疫功能低下，APACHEⅡ评分对评价免疫状态不敏感。

Objective To investigate the state of cellular and humoral immunity for patients with acute exacerbation of chronic obstructive pulmonary disease （ AECOPD ） and evaluate the correlation with acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ）. Methods The clinical data of patients with AECOPD were collected prospectively and their peripheral blood samples were got to test the indexes of cellular and humoral immunity in 24 h and 7th day after they were administrated to EICU and MICU. Cluster of differentiation CD3^＋ , CD4^＋ , CDs and CD4^＋/CD8^＋ were indexes as cellular immunity tested by flow cytometry and immunoglobulin （Ig）G, IgA, IgM as humoral immunity by nephelometry. Patients were divided to two groups（ ≤21 and 〉 21 ） according to score of APACHE Ⅱ and correlation with indexes of cellular and humoral immunity were compared. Results There were 75 cases with male/female 37/38,76.4 ± 9.8 years old of age and 22.8 ±5.3 score of APACHE Ⅱ. 37 eases were in group of ≤21 score of APACHE Ⅱ and 38 cases in another group of 〉 21. There were no significant differences for all indexes of cellular and humoral immunity in 24 h and 7th day after administrated to EICU and MICU between two groups （P 〉 0.05）. The same was as in group of ≤21 scores of APACHE Ⅱ except for group of 〉 21. The indexes of CD4^＋/CD8^＋ and IgG in group of 〉 21 were lower in 24h than in 7th day（P 〈 0.05 ）and the others were no significant differences（ P 〉0.05 ）. There were no correlation between all indexes and APACHE Ⅱ （r = 0. 163 - 0. 702 ,P 〉 0.05 ）. Conclusion Patients with AECOPD would have different lower level of immune station and APACHE Ⅱ score would not be sensitiv e score as immune station.