急性脑梗死患者并发脑卒中相关性肺炎外周血T淋巴细胞亚群与炎症因子的临床分析

Predictive value of T lymphocyte subsets and inflammatory factors for occurrence and severity of stroke associated pneumonia in patients with acute cerebral infarction

目的分析急性脑梗死(Acute cerebral infarction,ACI)患者外周血T淋巴细胞亚群与炎症因子对脑卒中相关性肺炎(Stroke associated pneumonia,SAP)的预测价值。方法回顾性分析2017年1月至2019年12月泰州市人民医院收治的225例ACI患者临床资料,根据是否发生SAP分为SAP组(n=86)和非SAP组(n=139)。收集所有患者入院时的临床资料,包括年龄、性别、血常规、T淋巴细胞亚群和炎症因子指标等。采用多因素Logistic回归分析ACI患者发生SAP的危险因素,并通过受试者工作特征曲线(ROC)分析不同指标预测SAP的价值。同时根据SAP病情严重程度评分系统将SAP患者分为低危38例,中危28例,高危20例,分析各组间外周血T淋巴细胞亚群和炎症因子的差异性。采用SPSS 23统计学软件分析数据。结果多因素Logistic回归分析显示,美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.113,95%CI 1.029~1.196,P<0.05)、血小板/淋巴细胞比值(PLR)(OR=1.035,95%CI 1.012~1.060,P<0.05)、C-反应蛋白(CRP)(OR=1.078,95%CI 1.009~1.091,P<0.05)为SAP发生的独立危险因素,而淋巴细胞计数(OR=0.424,95%CI 0.198~0.910,P<0.05)、CD4^(+)/CD8^(+)T淋巴细胞比值(OR=0.020,95%CI 0.002~0.280,P<0.05)为SAP发生的保护性因素。ROC曲线分析显示,NIHSS评分(AUC=0.920,95%CI 0.877~0.952,P<0.05)、淋巴细胞计数(AUC=0.860,95%CI 0.807~0.902,P<0.05)和CD4^(+)/CD8^(+)T淋巴细胞比值(AUC=0.871,95%CI 0.820~0.912,P<0.05)对SAP的预测价值较CRP(AUC=0.671,95%CI 0.606~0.732,P<0.05)和PLR(AUC=0.645,95%CI 0.578~0.707,P<0.05)大。高危SAP患者的NIHSS评分和CRP均高于低危SAP患者(t=2.341和3.058,P<0.05),而淋巴细胞计数和CD4^(+)/CD8^(+)T淋巴细胞比值均低于低危SAP患者(t=4.799和4.103,P<0.05)。高危SAP患者的CD4^(+)/CD8^(+)T淋巴细胞比值低于中危SAP患者(t=4.085,P<0.05)。结论ACI患者的病情严重程度、外周血淋巴细胞计数、CD4^(+)/CD8^(+)T淋巴细胞比值及CRP对SAP的发生及严重程度分级有预测价值。SAP的诊疗中应同时考虑ACI患者机体的免疫和炎症反应。

Objective To assess the predictive value of peripheral blood T lymphocyte subsets and inflammatory factors for occurrence and severity of stroke associated pneumonia(SAP)in patients with acute cerebral infarction(ACI).Methods Clinical data of 225 patients with ACI admitted to Taizhou People’s Hospital from January 2017 to December 2019 were retrospectively analyzed.According to the occurrence of SAP,the patients were divided into SAP group(n=86)and non-SAP group(n=139).General clinical data were collected for all patients at admission,including age,sex,blood routine and inflammation-related factors.Multivariate Logistic regression was used to analyze the risk factors for SAP in ACI patients,and the value of predicting the occurrence of SAP was analyzed by the receiver operating characteristic(ROC)curve.At the same time,SAP patients were divided into 38 cases of low-risk SAP,28 cases of medium-risk SAP,and 20 cases of high-risk SAP according the severity rating system of SAP,and the differences of peripheral blood T-lymphocyte subsets and inflammatory factors among each group were analyzed.SPSS 23 statistical software was used to analyze the data.Results Multivariate Logistic regression analysis showed that national institute of health stroke scale(NIHSS)score(OR=1.113,95%CI 1.029-1.196,P<0.05),platelet-lymphocyte ratio(PLR)(OR=1.035,95%CI 1.012-1.060,P<0.05),C-reacting protein(CRP)(OR=1.078,95%CI 1.009-1.091,P<0.05)were independent risk factors for SAP,while lymphocyte count(OR=0.424,95%CI 0.198-0.910,P<0.05)and CD4^(+)/CD8^(+)T lymphocyte ratio(OR=0.020,95%CI 0.002-0.280,P<0.05)were protective factors for SAP.ROC curve analysis showed that NIHSS score(AUC=0.920,95%CI 0.877-0.952,P<0.05),lymphocyte count(AUC=0.860,95%CI 0.807-0.902,P<0.05)and CD4^(+)/CD8^(+)T lymphocyte ratio(AUC=0.871,95%CI 0.820-0.912,P<0.05)had higher predictive value for SAP than CRP(AUC=0.671,95%CI 0.606-0.732,P<0.05)and PLR(AUC=0.645,95%CI 0.578-0.707,P<0.05).NIHSS score and CRP levels of high-risk SAP patients were higher than those of low-risk SAP patients(t=2.341 and 3.058,P<0.05),while lymphocyte count and CD4^(+)/CD8^(+)T lymphocyte ratio were lower than those of low-risk SAP patients(t=4.799 and 4.103,P<0.05).The CD4^(+)/CD8^(+)T lymphocyte ratio in high-risk SAP patients was lower than that in medium-risk SAP patients(t=4.085,P<0.05).Conclusion The NIHSS score,peripheral blood lymphocyte count,CD4^(+)/CD8^(+)T lymphocyte ratio and CRP levels have predictive value for the occurrence and severity of SAP in ACI patients.Both immune and inflammatory responses of ACI patients should be considered in the diagnosis and treatment of SAP.