心力衰竭合并细菌性肺炎患者血清炎性因子及外周血T细胞亚群的变化分析

Changes of serum inflammatory factors and peripheral blood T lymphocyte subsets in heart failure patients complicated with infectious pneumonia

目的探讨心力衰竭合并细菌感染性肺炎患者血清炎性因子、外周血T淋巴细胞亚群的变化及其意义。方法回顾性分析我院2015年3月—2017年8月收治的慢性心力衰竭患者109例病例资料,其中合并细菌感染性肺炎患者44例(心衰感染组)、未合并细菌感染性肺炎患者65例(单纯心衰组),比较2组治疗前、治疗后的血清降钙素原(procalcitonin,PCT)、CRP、IL-6、血浆脑钠肽(brain natriuretic peptide,BNP)、外周血中T淋巴细胞亚群(CD3^+、CD4^+、CD8^+T细胞)的水平。结果心衰感染组血清PCT、CRP、IL-6、BNP水平高于单纯心衰组(P均<0.05),CD3^+、CD4^+T细胞水平、CD4^+/CD8^+值低于单纯心衰组(P均<0.05),CD8^+T细胞水平与心衰组相比差异无统计学意义(P>0.05);心衰感染组和单纯心衰组患者在治疗后的血清PCT、CRP、IL-6、BNP水平较本组治疗前显著降低(P均<0.05),CD3^+、CD4^+T细胞水平、CD4^+/CD8^+值较本组治疗前显著升高(P均<0.05),CD8^+T细胞水平较本组治疗前变化不显著(P>0.05)。结论与单纯心衰患者比较,心力衰竭合并细菌感染性肺炎患者血清PCT、CRP、IL-6、BNP升高更加显著、免疫功能损害更加严重;对于心衰合并感染性肺炎的患者在治疗的过程中更应该重视免疫功能的调节。

Objective To investigate the changes and significance of serum inflammatory factors and peripheral blood T lymphocyte subsets in heart failure patients complicated with infectious pneumonia.Methods A total of 109 patients with chronic heart failure treated in our hospital from March 2015 to August 2017 were selected,including 44 cases of infectious pneumonia(infection group)and 65 cases of unassociated pneumonia patients(heart failure group).Their clinical data were retrospectively analyzed.The serum procalcitonin(PCT),CRP,IL-6,plasma brain natriuretic peptide(BNP)and peripheral blood T lymphocyte subsets(CD3+,CD4+,CD8+T cells)of patients in the 2 groups were detected and compared before and after treatment.Results The serum levels of PCT,CRP,IL-6 and BNP in the infection group were higher than those in the heart failure group(P<0.05).The CD3+T cells,CD4+T cells,CD4+/CD8+ratio in the infection group were lower than those in the heart failure group(P<0.05).The CD8+T cells showed no significant differences between the infection group and the heart failure group(P>0.05).The serum levels of PCT,CRP,IL-6,BNP in the infection group and the heart failure group were significantly decreased after treatment(P<0.05),while the CD3+T cells,CD4+T cells and CD4+/CD8+ratio were significantly increased compared with those levels before treatment(P<0.05).The CD8+T cells in the 2 groups were not significantly different before treatment and after treatment(P>0.05).Conclusions Compared with patients with heart failure alone,the serum levels of PCT,CRP,IL-6 and BNP in patients with heart failure complicated with infectious pneumonia are significantly increased and immune dysfunction is more apparent.Regulation of immune function should be paid attention in treatment of heart failure complicated with infectious pneumonia.