免疫功能监测在呼吸机相关肺炎患者预后评价中的作用

Effect of monitoring of immune function on the evaluation of prognosis in patients with ventilator-associated pneumonia

目的确定呼吸机相关肺炎(VAP)患者免疫功能与预后的相关性。方法选择我院接受机械通气治疗发生VAP的患者共70例,其中30例肺炎未控制、病情恶化,甚至死亡者为观察组,另40例经治疗后肺炎控制、疾病好转者为对照组,监测两组患者治疗前与治疗后体内T细胞亚群CD+4、CD+8值,计数CD+4/CD+8比,测定患者血浆免疫球蛋白Ig G、Ig A和Ig M数值,并统计分析。结果观察组治疗后CD+4降低、CD+8升高、CD+4/CD+8比下降(P<0.05),免疫球蛋白Ig G、Ig A和Ig M未见明显变化(P>0.05);与之相反,对照组治疗后CD+4升高、CD+8降低、CD+4/CD+8比上升(P<0.05),血浆免疫球蛋白Ig G、Ig A和Ig M明显升高(P<0.05)。结论 VAP患者免疫功能与预后呈明显相关性,CD+4降低、CD+8升高、CD+4/CD+8比下降者,多预示病情恶化,病情好转者血浆免疫球蛋白Ig G、Ig A和Ig M多明显升高,动态监测患者免疫指标对评价VAP预后具有重要的临床意义。

Objective To determine the correlation between the immune function and the prognosis of patients with ventilator-associated pneumonia（ VAP）. Methods 70 patients accepted mechanical ventilation and developed VAP were selected in our hospital,including 30 patients beyond control even death as the observation group and the rest 40 cases under control as the control group. The levels of CD^4＋,CD^8＋,CD^4＋/ CD^8＋of T cell subsets and Ig G,Ig A and Ig M were monitored before and after the treatment. Results After the treatment,the level of CD^4＋decreased,CD^8＋increased,and the ratio of CD^4＋/ CD^8＋decreased in the observation group,while Ig G,Ig A and Ig M values had no significant changes（ P〈0.05）. On the contrary after the treatment,the level of CD^4＋increased,CD^8＋decreased,and CD^4＋/ CD^8＋increased in the control group,and Ig G,Ig A and Ig M increased significantly（ P〈0.05）. Conclusion There is a significantly relationship between the immune function in patients with VAP and the prognosis. Patients with decreased CD^4＋,increased CD^8＋and decreased CD^4＋/ CD^8＋may have deterioration of the disease,while patients with increased Ig G,Ig A and Ig M indicate the improvement of the disease.