糖尿病患者免疫功能改变与预防肺部感染的临床研究

Clinical study on change of immune function of patients with diabetic mellitus and prevention of pulmonary infections

目的研究糖尿病肺部感染患者免疫功能变化,为减少患者医院感染率提供理论依据。方法选取2012年1月-2014年6月收治的129例糖尿病患者,其中32例医院肺部感染,观察患者肺部感染后发生的免疫学变化及治疗后免疫学指标的改善。结果糖尿病肺部感染率为24.81%;感染组和未感染组的可溶性白介素-2受体(SIL-2R)、G免疫球蛋白(IgG)、补体(C4)显著高于对照组,膜性白介素-2受体(MIL-2R)、自然杀伤细胞(NK)活性、CD4+/CD8+显著低于对照组,差异有统计学意义(P<0.01);感染组的SIL-2R、NK活性显著高于未感染组,C4、CH50显著低于未感染组,差异有统计学意义(P<0.01);糖尿病医院肺部感染患者治疗后血糖和肺部感染均得到控制11例占34.38%,糖尿病肺部感染患者治疗后所有指标均较治疗前有所改善,差异有统计学意义(P<0.01);治疗后SIL-2R水平下降,MIL-2R、NK活性、CD4+/CD8+水平增加,差异有统计学意义(P<0.01)。结论糖尿病患者肺部医院感染后免疫功能降低,通过对患者血糖的控制,能够降低患者肺部感染率。

OBJECTIVE To observe the change of immune function of the diabetic mellitus patients complicated with pulmonary infections so as to provide theoretical basis for reduction of incidence of nosocomial infections.METHODS A total of 129 diabetic mellitus patients who were treated in the hospital from Jan 2012 to Jun 2014 were enrolled in the study,including 32 cases of pulmonary infections.The immunological changes of the patients with pulmonary infections were analyzed,and the immunological indicators were observed after the treatment.RESULTS The incidence of pulmonary infections was 24.81%in the patients with diabetic mellitus.The levels of soluble interleukin-2receptor（SIL-2R）,immunoglobulin G（IgG）,and complement（C4）of the infection group and the non-infection group were significantly higher than those of the control group;the membranous interleukin-2receptor（MIL-2R）,activity of natural killer（NK）cell,and CD4^＋/CD8^＋of the infection group and the non-infection group were significantly lower than those of the control group,and there was statistically significant difference（P〈0.01）;the SIL-2Rand activity of NK cell of the infection group were significantly higher than those of the non-infection group,and the levels of C4 and CH50of the infection group were significantly lower than those of the non-infection group,with statistical significance（P〈0.01）.The blood glucose and pulmonary infections of 11（34.38%）diabetic mellitus patients have been controlled after the treatment of pulmonary infections,and all the indicators of the diabetic mellitus patients with pulmonary infections were significantly improved after the treatment,as compared with those before the treatment,and there was statistically significant difference（P〈0.01）.After the treatment,the level of SIL-2Rwas reduced,while the MIL-2R,activity of NK cell,and CD4^＋/CD8^＋were elevated,and there was statistically significant difference（P〈0.01）.CONCLUSION The immune function of the diabetic mellitus patients complicated with pulmonary infections is reduced,and the control of the blood glucose may contribute to the reduction of incidence of the pulmonary infections.