鲍氏不动杆菌医院获得性肺炎患者免疫功能及预后分析

Immunity function and prognosis in patients with hospital-acquired pneumonia due to Acinectobacter baumannii

目的探讨重症监护病房中多药耐药鲍氏不动杆菌(MDRAB)医院获得性肺炎(HAP)患者的免疫功能,各免疫指标对医院感染的预测价值及对预后的影响,以更好地指导临床工作,降低患者病死率。方法采用病例对照研究方法,回顾性分析2011年6月-2016年6月广西医科大学第一附属医院MDRAB HAP 87例为病例组,并选取同时期非MDRAB HAP 62例为对照组,比较两组患者T淋巴细胞、B淋巴细胞、免疫球蛋白、NK细胞计数等免疫指标及降钙素原、C-反应蛋白、白细胞等炎性指标,观察各免疫指标及炎性指标对医院感染的预测作用,应用单因素分析法进行比较两组中各免疫指标及炎性指标有无差异;应用ROC曲线评估各指标对医院感染的预测价值。结果 APACHEⅡ评分差异有统计学意义(P<0.05);对于免疫指标,两组总T细胞、CD_8^+T淋巴细胞、免疫球蛋白M、免疫球蛋白G、NK细胞均无统计学意义,但两组中CD_4^+T淋巴细胞差异有统计学意义(P<0.05),免疫球蛋白A水平有显著差异(P<0.05),绘制CD_4^+T淋巴细胞和免疫球蛋白A预测HAP的ROC曲线均具有较大诊断价值;炎性指标的研究中,患者白细胞计数、中性粒细胞百分比、降钙素原、C-反应蛋白比较差异无统计学意义,但淋巴细胞差异有统计学意义(P<0.05)。结论免疫指标CD_4^+T细胞、免疫球蛋白A、APACHEⅡ评分对指导重症监护病房中HAP患者的临床治疗有重要价值,对MDRAB HAP患者的免疫功能及其预后的评估具有重要意义。

OBJECTIVE To analyze the immunity function and prognosis of hospital acquired pneumonia due to multidrug-resistant Acinectobacterbaumannii （MDRAB）,so as to better guide the clinical work,and decrease the mortality of patients.METHODS A total of 87 cases of hospital-acquired pneumonia caused by MDRAB in the first Affiliated Hospital of Guangxi Medical University from Jun.2011 to Jun.2016 were retrospectively analyzed by case-control method.Additional 62 cases of hospital-acquired pneumonia caused by non MDRAB were included as control group.The immune indicators including T lymphocyte,B lymphocyte,immunoglobulins and NK cell count,and inflammatory indicators including procalcitonin,C reactive protein and leukocyte between the two groups were compared.The prediction of nosocomial infection by immune and inflammatory indicators was observed.Univariate analysis was used to compare the difference of immune indicators and inflammatory indicators between the two groups.The ROC curve was used to evaluate the predictive value of each indicator.RESULTS The difference of APACHEⅡ score was significant （P〈0.05）.For immune indicators,the total T cells,CD8＋ T lymphocytes,immunoglobulin M,immunoglobulin G,and NK cells between the two groups were not significant,but the difference of CD4＋ T lymphocytes between the two groups was significant （P〈0.05）.Drawing of ROC curves of CD4 ＋ T lymphocytes and immunoglobulin A had a great diagnostic value for the prediction of HAP.For inflammatory indicators,there were no significant differences in leukocyte count,neutrophil percentage,procalcitonin and C-reactive protein,but the difference in lymphocyte was statistically significant （P 〈 0.05）.CONCLUSION The CD4 ＋ T cell,immunoglobulin A and APACHE Ⅱ scores were of great value to guide the clinical treatment of HAP patients in ICU,and of great significance to evaluate the immune function and prognosis of patients with MDRAB HAP patients.