脑卒中患者肺部感染体液及细胞免疫功能变化研究

Changes of humoral and cellular immunity in stroke complicated with pulmonary infections

目的探讨脑卒中患者肺部感染体液及细胞免疫功能的变化,为临床预防治疗及预后提供帮助。方法选取医院2013年1月-2015年6月收治的脑卒中患者84例为研究对象,根据有无肺部感染症状分为感染组44例及对照组40例,采用免疫比浊法检测所有患者的血清IgA、IgG、C3、C4等,观察体液免疫功能变化,并采用流式细胞仪检测患者外周血T淋巴细胞亚群CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+等,观察细胞免疫功能变化,并通过对患者治疗前后神经功能缺损评分评估疗效。结果感染组脑梗死患者的病灶均主要集中于颞顶额叶及枕颞叶,占25.00%,脑出血患者病灶主要集中于脑叶区,占27.27%;感染组患者IgA、IgG、C3、C4含量均明显低于对照组相应蛋白含量,差异有统计学意义(P<0.05);感染组患者CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+含量明显低于对照组,差异有统计学意义(P<0.05);感染组有2例死亡,对照组无死亡病例,感染组患者的治愈率及总有效率为15.91%及65.91%,均明显低于对照组97.50%及40.00%,差异有统计学意义(P<0.05)。结论免疫功能的降低与脑卒中患者肺部感染密切相关,对患者免疫功能的监测,有助于临床治疗及病情的转归。

OBJECTIVE To study the changes of humoral and cellular immunity in stroke complicated with pulmonary infections,in order to facilitate clinical treatment and prognosis.METHODS Totally 84 patients with stroke in our hospital from Jan.2013 to Jun.2015 were selected as subjects and divided into the infection group of 44 cases and the control group of 40 cases by occurrence of pulmonary infections.IgA,IgG,C3,C4 of all patients were detected by immunoturbidimetry to observe changes in humoral immunity and CD3^＋,CD4^＋,CD8^＋,CD4^＋/CD8^＋were detected by flow cytometry to observe changes in cellular immunity,the curative effect was evaluated by NIHSS scores.RESULTS In the infection group,the lesions of cerebral infarction were mainly concentrated in frontal lobe and temporal lobe,accounting for 25.00%;the lesions of cerebral hemorrhage were mainly concentrated in lobar brain,accounting for 27.27%.IgA,IgG,C3,C4 of the infection group were significently lower than those of the control group（P〈0.05）;CD3^＋,CD4^＋,CD8^＋,CD4^＋/CD8^＋of the infection group were significently lower than those of the control group（P〈0.05）.There were 2dead cases in the infection group,no dead cases in the control group.The cure rate（15.91%）and the total efficiency（65.91%）of the infection group were significently lower than those（97.50%,40.00%）of the control group（P〈0.05）.CONCLUSION The lowered immunologic function of stroke patients is closely related to pulmonary infection.Monitoring of immunologic function is helpful for clinic treatment and prognosis.