结核重症监护室患者外周血CD4^+ T淋巴细胞的检测与临床意义

Detection and clinical significance of peripheral blood CD4^+ lymphocyte in ICU patients

目的探讨结核重症监护室(ICU)患者外周血CD4^+T淋巴细胞(简称CD4^+)的变化及意义,以判断患者的病情及预后。方法收集2015年3月-2016年8月我院ICU住院患者126例为观察组,并随机选取同期普通结核科住院患者62例为对照组,所有患者均于清晨空腹采集静脉血2 mL送检,采用流失细胞仪分别检测两组人员的外周血CD4+T淋巴细胞数量;另将观察组按CD4^+检测水平分成低水平组(CD4^+<400 cell/ul)和正常水平组(CD4^+≥400 cell/ul);比较观察组和对照组CD4^+水平,并统计分析ICU不同CD4^+水平组患者的APACHII评分及预后等情况。结果观察组外周血CD4+T淋巴细胞数量明显低于对照组(395.33±242.17 vs 635.03±318.78 cell/ul,P<0.01);ICU低CD4+水平组患者的APACHII评分(23.40±5.05 vs 20.41±3.55)及死亡率(66.2%vs 15.5%)均明显高于正常水平组,差异均有统计学意义(P<0.01)。结论相比普通结核科患者而言,结核重症监护室患者机体细胞免疫功能更低;外周血CD4+T淋巴细胞水平可协助判断患者的病情严重程度及预测死亡预后。

Objective To investigate the changes of CD4^+ lymphocyte in the peripheral blood and its clinical significance in the patients of tuberculosis intensive care unit (ICU). Methods 126 cases of ICU patients in our hospital from March 2015 to August 2016 were selected as the observation group, and 62 cases of normal hospitalized patients were randomly selected as the control group. All subjects received blood sampling by 2 ml with an empty belly in the morning. Peripheral blood CD4 ^+ lymphocytes were detected by flow cytometry. The observation group was divided into a lower level group with CD4^+<400 cell/ul and normal group with CD4 +≥400 cell/ul. Compare the different groups and analyze the correlation with severity and prognosis of tuberculosis ICU patients. Results The count of peripheral blood CD4^+ lymphocytes in the observation group was significantly lower than the control group (395.33±242.17 vs 635.03±318.78 cell/ul, P <0.01);The Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (23.40±5.05 vs 20.41±3.55)and the mortality(66.2% vs 15.5%) of the low CD4^+ group were significantly higher than the normal CD4^+ group ( P <0.01). Conclusion Compared with the common tuberculosis patients, patients in tuberculosis ICU had more poor cellular immune function;the level of peripheral blood CD4 ^+ lymphocytes can be used to make a judgment of severity and prognosis of tuberculosis ICU patients.