外周血CD8^+T细胞亚群对ICU重症患者侵袭性肺部真菌感染的预测价值

Predictive value of peripheral blood CD8^+T cell subsets in ICU patients with severe invasive pulmonary fungal infections

目的探讨外周血CD8+、CD8+CD28+、CD8+CD38+对ICU重症患者侵袭性肺部真菌感染的预测价值。方法选择IPFI、非IPFI肺部感染及无肺部感染的ICU患者分为IPFI组、肺炎组和非肺炎组,采用流式细胞仪技术检测外周血CD8+、CD8+CD28+、CD8+CD38+水平。结果低蛋白血症、糖尿病、慢性肺阻塞性肺疾病、呼吸衰竭、2种以上抗生素、糖皮质激素、免疫抑制剂、机械通气等均为重症患者IPFI危险因素(P<0.05),其中慢性肺阻塞性肺疾病、呼吸衰竭、糖皮质激素、免疫抑制剂等为重症患者IPFI独立危险因素(P<0.05)。肺炎组和IPFI组第1、3、7天的CD8+、CD8+CD28+、CD8+CD38+百分率与对照组比较,差异均有统计学意义(P<0.05)。CD8+、CD8+CD28+、CD8+CD38+对IPFI均具有预测价值(P<0.05),其中CD8+CD28+的预测价值较高,敏感度和特异度分别为0.72和0.83。结论外周血CD8+、CD8+CD28+、CD8+CD38+T细胞水平改变能够反应IPFI进展过程,CD8+CD28+T细胞对IPFI具有较可靠的预测价值。

Objective To investigate the predictive value of peripheral blood CD8^＋, CD8^＋ CD28^＋, CD8^＋ CD38^＋ in ICU patients with severe invasive pulmonary fungal infections. Methods IPFI, non IPFI lung infection and infection in ICU patients without lung were divided into IPFI group, pneumonia group and non-pneumonia group, flow cytometry was used to detect peripheral blood CD8^＋, CD8^＋ CD28^＋, CD8^＋ CD38^＋ levels. Results Hypoalbuminemia, diabetes, chronic pulmonary obstructive pulmonary disease, respiratory failure, two or more antibiotics, corticosteroids, immunosuppres- sive agents, mechanical ventilation were risk factors in patients with severe IPFI （P 〈 0.05）, in which chronic pul- monary obstructive pulmonary disease, respiratory failure, corticosteroids, immunosuppressive agents such as patients with severe IPFI independent risk factors （P 〈 0.05）. Pneumonia group and IPFI group on 1,3,7-day CD8^＋, CD8^＋ CD28^＋, CD8^＋ CD38^＋ hundred percent compared with the control group, the difference were statistically significant（P 〈 0.05）. CD8^＋, CD8^＋ CD28^＋, CD8^＋ CD38^＋ fight IPFI all had predictive value （P 〈 0.05）, in which the CD8^＋ CD28^＋ high predictive value, sensitivity and specificity were 0.72 and 0.83, respectively. Conclusion Peripheral blood CD8^＋, CD8^＋ CD28^＋, CD8^＋ CD38^＋ level changes could reflect the occurrence and development IPFI, CD8^＋ CD28^＋ fight IPFI with a more reliable predictive value.