轻症卒中及重症卒中感染患者免疫功能变化的对照研究

Comparative study on change of immune function in patients with mild stroke and severe stroke

目的：探讨轻症卒中及重症卒中患者的感染情况以及免疫功能变化情况。方法：选取我院2011年1月一2014年9月收治的155例急性脑卒中患者作为研究对象，其中重症卒中84例，轻症卒中71例，比较两组感染情况、炎症指标及免疫指标变化情况，同时探讨影响卒中患者预后的影响因素。结果：155例急性脑卒中患者中，109例发生感染，感染发生率为70．32％，其中重症卒中感染率为84．52％，轻症卒中感染率为53．52％，重症卒中感染率明显高于轻症卒中（P〈0．01）；重症卒中组患者的中性粒细胞、白细胞计数、Hs—CRP、PCT水平均显著高于轻症卒中组（P〈0．01）；重症卒中组患者的淋巴细胞、HLA—DR、CD3＋、CD4＋、CD8＋水平均显著低于轻症卒中组（P〈O．01）；卒中感染组患者的淋巴细胞、HLA～DR、CD3＋、CD4＋、CD8＋水平均显著低于未合并感染组（P〈0．01）；经多因素Logistics回归分析结果显示，PCT是影响预后的独立危险因素，HLA—DR、CD4＋是影响预后的独立保护因素。结论：卒中后感染率高，重症卒中相对于轻症卒中感染程度更重，免疫功能更差，其中PCT是影响预后的独立危险因素，HLA—DR、CD4＋是影响预后的独立保护因素。

Objective： To discuss the infection status and immune function changes of patients with mild stroke and severe stroke . Methods： 155 cases of acute stroke patients admitted in our hospital from January 2011 to September 2014 were selected as the study objects, indcluding 84 cases of patients with severe stroke and 71 cases of patients with mild stroke. The infection status, inflammatory index and immune index of patients were compared between two groups. At the same time, the influence factors of the prognosis of stroke patients were explored.. Results： 155 cases of acute stroke patients, 109 cases of patients infected , the incidence of infection was 70.32%, the infection rate of severe stroke was 84.52%, the infection rate of mild cases was 53.52% , the infection rate of severe stroke was significantly higher than that of mild stroke （P〈0.01）; The levels of neutrophils, white blood cell count, PCT and Hs-CRP of patients with severe stroke were significandy higher than those of patients of the mild group; The levels of lymphocytes, HLA-DR, CD3＋, CD4＋ and CD8＋ of the patients with severe stroke were significantly lower than those of patients of the mild group （P〈0.01）; The levels of lymphocytes, HLA-DR, CD3 ＋, CD4＋ and CD8 ＋ in patients with stroke were sigrtificandy lower than those of patients of uncombined infection group （P〈0.01） ; The results of multivariate Logstics regression analysis showed , PCT was an independent risk factor for prognosis, CD4 ＋ and HLA-DR were independent protective factors of affecting prognosis. Conclusion： Infection rate after stroke is high, infection degree of severe stroke is higher than that of light stroke ,it has worse immune function, PCT is an independent risk factor for prognosis, and CD4＋ and HLA-DR are independent protective factors of affecting prognosis.