持续性植物状态高龄患者感染前后血浆白蛋白水平及细胞免疫功能的变化

Changes in Plasma Albumin Levels and Cellular Immune Function in Elderly Patients in Persistent Vegetative State before and after Infection

目的探讨持续性植物状态(persistent vegetative state,PVS)高龄患者感染前后血浆白蛋白(albumin,ALB)水平及细胞免疫功能的变化及关系。方法 PVS高龄患者共78人,按感染前(B组)、感染5天(C组)、感染10天(D组)、严重脓毒症(severe sepsis)/脓毒性休克(septic shock)(E组)分组检测患者血浆ALB水平、细胞免疫功能[包括外周血单核细胞(peripheral blood mononuclear cell,PBMC)表面人白细胞抗原-DR(human leukocyte antigen-DR,HLA-DR)及T细胞亚群];随机选择同期住院的非PVS、无感染的高龄患者40人为对照组(A组)。结果与A组比较,B组血浆ALB明显减低(P=0.000);与A组及B组相比,C、D、E3组血浆ALB均明显减低(P=0.000)。与A组比较,感染前血浆ALB在正常范围的PVS高龄患者(B1组)其细胞免疫功能无明显差异,而感染前血浆ALB减低的PVS高龄患者(B2组)其HLA-DR的表达、CD3+T细胞绝对值以及CD4+/CD8+比值均明显减低(P=0.000),CD8+T细胞占CD3+T细胞的百分数显著升高(P=0.000),CD4+T细胞占CD3+T细胞的百分数尚未见明显差异。与A组及B组比较,C、D、E3组HLA-DR的表达、CD3+T细胞的绝对值、CD4+T细胞占CD3+T细胞的百分数以及CD4+/CD8+比值均明显减低(P=0.000),CD8+T细胞占CD3+T细胞的百分数显著升高(P=0.000);上述各免疫指标的变化与血浆ALB水平的相关系数分别为0.791、0.638、0.534、-0.575、0.580(P均=0.000)。结论 PVS高龄患者感染前血浆ALB就已显著减低,感染后血浆ALB水平进一步下降,血浆ALB减低的患者其细胞免疫功能也减低,而且患者感染前后细胞免疫功能的下降与血浆ALB水平的降低密切相关。

Objective To investigate changes in plasma albumin （ALB） levels and cellular immune function and their relationship in elderly patients in persistent vegetative state （PVS） before and after infection. Methods Seventy- eight elderly patients in PVS were divided into groups （B, pre-infection; C, 5-day infection; D, 10-day infection; E severe sepsis/septic shock） and compared to a control group consisting of 40 elderly patients （A, hospitalized during the same pe- riod, no PVS or infection）. Plasma ALB levels and cellular immune function （including peripheral blood mononuclear cell surface human leukocyte antigen-DR （HLA-DR） and T cell subsets） were examined. Results Plasma ALB level was sig- nificantly lower in group B than group A and significantly lower in groups C, D, and E than in groups A and B. Cellular im- mune function was similar in group B1 （patients in PVS whose plasma ALB was within the normal range before infection） and group A. Patients in PVS whose plasma ALB was reduced before infection （group B2 ） had significantly reduced in ①expression of HLA-DR, ②absolute number of CD3 ＋ T cells, and ③CD4＋/CD8＋ ratio, increased in ④percentage of CD8＋ T cells among CD3＋ T cells, and remained unchanged in ⑤percentage of CD4＋ T ceils among CD3＋ T. Immunological in- dicators ①, ②, ③ and ⑤ were significantly lower and immunological indicator ④ was significantly higher in groups C, D and E than in groups A and B. The changes in these indicators were correlated with plasma ALB level. Conclusion Plasma ALB level is significantly reduced in elderly patients in PVS before infection, and declines steadily thereafter. The decline in cellular immune function before and after infection is closely associated with reduction in plasma ALB levels.