持续性植物状态高龄患者医院感染前后免疫功能变化研究

Change of immune function of elderly patients in persistent vegetative state before and after nosocomial infections

目的探讨持续性植物状态(PVS)高龄患者医院感染前后的免疫功能变化及应用抗菌药物治疗的效果。方法选取2013年2月-2014年4月呼吸科住院的非PVS非感染高龄患者的33例为对照组(A组),另外选取同期住院的PVS高龄患者70例,其中感染前34例(B组)、感染后36例(C组),检测各组的血清免疫球蛋白和细胞免疫功能的变化。结果 C组人白细胞dr抗原(HLA-DR)的表达(63.6±6.3)%、CD3+T细胞绝对值(489±134)个/μl等,同A组(93.4±3.2)%、(1228±380)个/μl和B组(78.6±5.9)%、(789±138)个/μl相比均明显减低(P<0.05),且C组CD8+T细胞占CD3+T细胞的百分数(40.8±7.6)%,同A组(26.3±9.8)%和B组(33.8±9.1)%相比,明显升高(P<0.05);与A组患者比较,B组和C组的血清球蛋白有显著下降,C组在接受抗菌药物治疗后,感染类并发症的发生明显下降,差异均有统计学意义。结论呼吸科PVS高龄患者发生医院感染后,其免疫功能显著降低,经抗菌药物治疗后,能有效的减少感染率及感染类并发症的发生。

OBJECTIVE To explore the change of immune function of the elderly patients in persistent vegetative state（PVS）before and after nosocomial infections and observe the therapeutic effects of antibiotics.METHODS A total of 33non-PVS or non-infection elderly patients who were hospitalized the respiratory medicine department from Feb 2013 to Apr 2014 were assigned as the control group（group A）,meanwhile,70 elderly PVS patients who were hospitalized during the same period were enrolled in the study,including 34 cases before the infections（group B）and 36 cases after the infections（group C）.The changes of the serum immunoglobulins and cellular immune function were observed.RESULTS The expression of human leukocyte antigen DR（HLA-DR）of the group C was（63.6±6.3）%,significantly lower than（93.4±3.2）% of the group A and（78.6±5.9）% of the group B;the absolute value of CD3^＋T cells of the group C was（489±134）/μl,significantly less than（1228±380）/μl of the group A and（789±138）/μl of the group B（P〈0.05）.The percentage of CD8^＋T cells in the CD4^＋T cells was（40.8±7.6）%in the group C,significantly higher than（26.3±9.8）%in the group A and（33.8±9.1）%in the group B（P〈0.05）.As compared with the group A,the serum immunoglobulins levels of the group B and the group C were significantly reduced.The incidence of the complication of infections was remarkably decreased in the group C after the antibiotic therapy,with significant difference.CONCLUSIONThe immune functions of the elderly PVS patients of the respiratory medicine department are significantly reduced after they have nosocomial infections,and the antibiotic therapy can effectively reduce the infections rate and the incidence of the complication of infections.