慢性肾脏病患者年龄对T淋巴细胞亚群及细菌感染的影响

Influence of Age on Bacterial Infections and T Lymphocyte Subsets in Patients with Chronic Kidney Disease

目的探讨慢性肾脏病(chronic kidney disease,CKD)患者年龄对外周血T淋巴细胞亚群水平及细菌感染的影响,为CKD患者感染的防治提供依据。方法选取2010年1月~2014年12月于内蒙古自治区人民医院肾内科住院治疗的CKD患者447例。其中除外系统性红斑狼疮、血管炎等自身免疫性疾病并且2年内未使用激素或免疫抑制剂治疗患者165例(筛选病例)。根据2016年WHO建议的年龄划分标准,将患者分为青年组(<45岁)、中年组(45~59岁)、老年组(≥60岁),并且将老年组分为低龄老年组(60~74岁)和高龄组(≥75岁)两个亚组。所有受试者采用流式细胞仪测定外周血CD3^+、CD4^+、CD8^+T淋巴细胞绝对计数。结果CKD患者中随着年龄增长,感染率不断上升,发生感染患者的T淋巴细胞CD3^+、CD4^+、CD8^+水平也明显低于非感染患者。T淋巴细胞计数和肾小球滤过率估算值(eGFR)随着年龄增长而逐渐下降,年龄和淋巴细胞水平呈负相关。多因素线性回归分析表明,年龄是T淋巴细胞CD3^+、CD4^+、CD8^+水平下降的独立危险因素。结论CKD患者随着年龄增长,感染发生率不断增高,并且与T淋巴细胞水平密切相关。监测CKD患者外周血淋巴细胞数,尤其根据年龄调整监测频率,及时调整感染疾病的预防及治疗方案,是CKD患者防控感染的重要措施。

Objective To investigate the effects of age of chronic kidney disease(CKD)patients on T lymphocyte subsets in peripheral blood and their infection,and to provide evidence for the prevention and treatment of CKD patients.Methods A total of 447 patients with CKD who were hospitalized in the Department of Nephrology,Inner Mongolia Autonomous Region People′s Hospital from January 2010 to December 2014 were selected.Among them,165 patients with autoimmune diseases such as systemic lupus erythematosus and vasculitis who were not treated with hormones or immunosuppressants within 2 years(screening cases)were excluded.According to the 2016 age classification criteria recommended by the WHO,patients were divided into young(<45 years old),middle-aged(45-59 years old),and elderly(≥60 years old)groups,and the elderly group was divided into younger age groups(60-74 years old)and older group(≥75 years old).All subjects used flow cytometry to measure the absolute counts of peripheral blood CD3+,CD4+,and CD8+T lymphocytes.Results As the CKD patients grew older,the infection rate continued to increase,and the levels of CD3^+,CD4^+,and CD8^+in T lymphocytes of patients with infection were significantly lower than those of non-infected patients.The T lymphocyte count and the estimated value of glomerular filtration rate(eGFR)gradually decrease with age,and there is a negative correlation between age and lymphocyte levels.Multivariate linear regression analysis showed that age was an independent risk factor for the decline of CD3^+,CD4^+,and CD8^+levels of T lymphocytes.Conclusion With the increase of age,the incidence of CKD patients is increasing,and it is closely related to the level of T lymphocytes.Monitoring the number of peripheral blood lymphocytes in CKD patients,especially adjusting the monitoring frequency according to age,and timely adjusting the prevention and treatment of infections are important measures for CKD patients to prevent and control infection.