外周血T淋巴细胞亚群计数、APACHEⅡ对成人社区获得性肺炎短期预后的临床价值

Clinical Value of Peripheral Blood T Lymphocyte Subgroup Count and APACHE II for Short-term Prognosis of Community-acquired Pneumonia in Adults

目的探讨外周血T淋巴细胞亚群计数及急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)对成人社区获得性肺炎(community acquired pneumonia,CAP)短期不良预后的预测价值及其危险因素分析。方法回顾性分析徐州医科大学附属医院2020年1月~2021年8月收治入院的CAP患者160例,根据患者住院结局及出院后30天预后情况,分为死亡组与存活组。比较两组患者T淋巴细胞亚群计数、APACHEⅡ、CURB-65评分、肺炎严重指数(PSI)、降钙素原(PCT)、白细胞计数(WBC)、淋巴细胞计数(LC)、中性粒细胞百分比(NEU%)等炎性指标之间的差异。使用受试者工作特征(ROC)曲线分析各项指标对CAP患者短期不良预后的预测价值。采用Logistic回归分析CAP患者死亡危险因素,差异有统计学意义(P<0.05)。结果死亡组CD4^(+)、CD8^(+)、CD3^(+)T淋巴细胞计数及LC明显低于存活组,APACHEⅡ、CURB-65、PSI、PCT、WBC、NEU%明显高于存活组(P<0.05)。CD4^(+)、CD8^(+)、CD3^(+)T淋巴细胞计数预测CAP患者预后的ROC曲线下面积(AUC)分别为0.779、0.736和0.784,其临界值分别为414个/微升、314个/微升、754个/微升,其AUC<3项评分,>炎性指标。APACHEⅡ临界值为14.5分,敏感度80.0%,特异性85.2%。CD4^(+)T淋巴细胞计数、APACHEⅡ、WBC为成人CAP患者死亡的独立危险因素。结论成人CAP患者预后不良与细胞免疫功能减低密切相关,APACHEⅡ评分预测CAP预后的价值较高,可监测CAP患者全身健康状况及T淋巴细胞亚群计数为评估其预后提供重要信息。

Objective To investigate the predictive value of peripheral blood T lymphocyte subsets count and acute physiology and chronic health evaluationⅡ(APACHEⅡ)for short-term adverse prognosis of community acquired pneumonia(CAP)in adults,as well as risk factors for poor prognosis.Methods A total of 160 CAP patients in adults admitted to The Affiliated Hospital of Xuzhou Medical University from January 2020 to August 2021 were retrospectively analyzed,and they were divided into death group and survival group according to hospitalization outcome and 30-day prognosis after discharge.Peripheral blood T lymphocyte subset count,APACHEⅡ,CURB-65 score,pneumonia severity index(PSI),procalcitonin(PCT),white blood cell count(WBC),lymphocyte count(LC)and neutrophil percentage(NEU%)were compared between two groups.Receiver operating characteristic(ROC)curves were used to analyze the predictive value of each indicator for short-term adverse outcomes in CAP patients in adults.Risk factors of death in CAP patients in adults were analyzed by Logistic regression.Results CD4^(+),CD8^(+),CD3^(+)T lymphocyte count and LC in death group were significantly lower than those in survival group,while APACHEⅡ,CURB-65,PSI,PCT,WBC and NEU%were significantly higher than those in survival group(P<0.05).The area under ROC curve(AUC)of CD4^(+),CD8^(+)and CD3^(+)T lymphocyte counts in predicting prognosis of CAP patients were 0.779,0.736,and 0.784 respectively.The critical values were 414/μl,314/μl,and 754/μl respectively.The AUC was smaller than the three scores and larger than the inflammatory index.The APACHEⅡcritical value was 14.5 points,the sensitivity was 80.0%and the specificity was 85.2%.CD4^(+)T lymphocyte count,APACHEⅡand WBC were independent risk factors for CAP patients in adults.Conclusion The poor prognosis of CAP patients in adults is closely related to the decrease of cellular immune function.APACHEⅡscore has a high prognostic value in prognosis of CAP.Monitoring the overall health status and peripheral blood T lymphocyte subsets count of CAP patients in adults provides important information for the evaluation of prognosis.