间质性肺炎合并真菌感染病原学和T淋巴细胞免疫特征

Study on etiological characteristics of interstitial pneumonia complicated with fungal infection and change of T lymphocyte immune

目的探讨间质性肺炎合并真菌感染的病原学特点和T淋巴细胞免疫改变研究。方法收集赣南医学院第一附属医院呼吸科2014年5月-2019年5月收治的间质性肺炎合并真菌感染患者30例作为研究对象,纳入感染组,选择同期于赣南医学院第一附属医院进行治疗的间质性肺病(ILD)未合并感染者50例,纳入非感染组,并随机选择50名健康体检者纳入对照组;对感染组患者真菌病原分布特点进行分析;对三组肺功能指标1秒用力呼气容积(FEV1)、第一秒用力呼气量占所有呼气量的比例(FEV1/FVC)及最大通气量(MVV)、全身炎性指标C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)和免疫指标CD4+、CD8+、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平进行比较。结果 ILD患者合并真菌感染以白假丝酵母为主,占66.67%;三组肺功能指标(FEV1、FEV1/FVC、MVV)、全身炎症指标(CRP、PCT、IL-6)、T淋巴细胞免疫指标(CD4+、CD8+、IgA、IgG、IgM)整体差异具有统计学意义(P<0.05),其中感染组FEV1、FEV1/FVC、MVV、CD4+水平低于非感染组及对照组(P<0.05),CRP、PCT、IL-6、CD8+、IgA、IgG、IgM水平高于非感染组及对照组(P<0.05)。结论间质性肺炎合并真菌感染以白假丝酵母为主,患者伴有明显的呼吸功能下降、全身炎症水平升高、T淋巴细胞免疫水平降低,应加强对真菌感染的筛查。

OBJECTIVE To investigate the pathogenic characteristics of interstitial pneumonia complicated with fungal infection and to analyze T lymphocyte immune change. METHODS All 30 patients with interstitial pneumonia complicated with fungal infection who were admitted to the Department of Respiratory Medicine at the First Affiliated Hospital of Gannan Medical College from May 2014 to May 2019 were recruited and divided into the the infection group;50 ILD patients without infection during the same period was in the non-infected group;the other 50 healthy volunteers under physical examination were randomly enrolled in the control group. The distribution characteristics of fungal pathogens in the infected group were analyzed;the lung function indexes including forced expiratory volume in 1 second(FEV1), the ratio of forced expiratory volume in the first second to all expiratory volumes(FEV1/FVC) and maximum ventilation(MVV), systemic inflammatory index C-reactive protein(CRP), The levels of procalcin(PCT), interleukin-6(IL-6), immune indicators of CD4+ and CD8+, immunoglobulin A(IgA), immunoglobulin G(IgG), and immunoglobulin M(IgM) in the three groups were analyzed. RESULTS Pathogens in ILD patients with fungal infections were mainly Candida albicans(66.67%). The differences of lung function indicators(FEV1, FEV1/FVC and MVV), systemic inflammation indicators(CRP, PCT and IL-6), T cell immune indicators(CD4+, CD8+, IgA, IgG, and IgM) in the three groups were significant(P<0.05). The levels of FEV1, FEV1/FVC, MVV and CD4+ in the infected group were significantly lower than those in the non-infected group and the control group(P<0.05);levels of CRP, PCT, IL-6, CD8+, IgA, IgG and IgM were significantly higher than those in the non-infected group and the control group(P<0.05). CONCLUSION The main strain of pathogen in patients with interstitial pneumonia combined with fungal infection is C. albicans. Patients are accompanied by a significant decrease in respiratory function, an increase in systemic inflammation and a decrease in T cell immunity levels. Screening for fungal infection should be paid attention.