老年2型糖尿病合并肺部感染患者免疫状态和预后的危险因素分析

Analysis of risk factors for immune status and prognosis in elderly patients with type 2 diabetes mellitus complicated with pulmonary infection

目的探讨影响老年2型糖尿病(type 2 diabetes,T2DM)合并肺部感染患者预后的相关因素。方法选取2019年8月至2020年6月南京医科大学附属淮安第一医院收治的单纯T2DM患者135例,单纯肺部感染患者128例及T2DM合并肺部感染患者124例,分别记为T2DM组、肺部感染组及T2DM合并肺部感染组。对比三组患者血免疫指标及炎症因子水平。随访6个月,分析老年T2DM合并肺部感染患者预后死亡情况,依据是否发生死亡,将患者分为死亡组和存活组,并对比患者死亡组和存活组患者临床资料,Logistic多因素回归分析影响老年T2DM合并肺部感染患者预后死亡的相关因素。结果T2DM合并肺部感染组患者CD4^(+)、CD4^(+)/CD8^(+)比值均低于T2DM组和肺部感染组[(31.98±3.72)%比(42.16±5.27)%比(37.42±4.61)%,(0.81±0.15)比(1.42±0.38)比(1.13±0.21),F值分别为61.09、66.60,P值均<0.05)];T2DM合并肺部感染组患者的CD8^(+)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C reactive protein,CRP)水平均高于T2DM组和肺部感染组[(40.06±4.06)%比(30.43±3.65)%比(33.21±3.52)%、(62.75±6.18)ng/mL比(51.25±5.96)ng/mL比(36.86±6.83)ng/mL、(4.03±0.68)μg/mL比(1.95±0.34)μg/mL比(2.18±0.42)μg/mL、(13.27±4.86)mg/mL比(4.15±1.27)mg/mL比(7.25±2.05)mg/mL,F值分别为87.32、42.27、68.32、89.61,P值均<0.05)]。老年T2DM合并肺部感染患者死亡率为15.32%(19/124)。死亡组患者肺部感染病原菌真菌占比、日平均血糖波动幅度(average blood glucose fluctuation range,MAGE)、血糖标准差(blood glucose standard deviation,SDBG)、急性生理与慢性健康(acute physiology and chronic health score,APACHE)评分及CRP水平均高于存活组[26.32%比5.71%、(5.62±1.06)mmol/L比(3.98±0.75)mmol/L、(3.28±0.92)mmol/L比(2.45±0.56)mmol/L、(28.92±6.83)比(24.36±5.65)、(15.38±3.16)g/L比(12.91±2.62)g/L,χ2/t值分别为8.45、3.19、2.32、3.33、3.66,P值均<0.05],死亡组患者CD4^(+)/CD8^(+)比值则低于存活组[(0.75±0.05)比(0.82±0.07),t=4.16,P<0.05]。Logistic回归结果显示,APACHE评分、CD4^(+)/CD8^(+)比值及CRP均为影响老年T2DM合并肺部感染患者死亡的有关因素(OR=2.95、3.98、3.51,P值均<0.05)。结论老年T2DM合并肺部感染患者血免疫指标及炎症因子均存在异常,APACHE评分、CD4^(+)/CD8^(+)比值及CRP均为老年T2DM合并肺部感染患者死亡的影响因素,临床中需注意防控,并及时做好应对措施。

Objective To explore the factors affecting the prognosis of elderly type 2 diabetes(T2DM)patients with pulmonary infection.Methods From August 2019 to June 2020,patients with pure T2DM(135 cases),patients with pure pulmonary infection(128 cases)and patients with T2DM complicated with pulmonary infection(124 cases)admitted to the Medicine of Huai'an First Hospital Affiliated to Nanjing Medical University were selected and recorded as T2DM group,pulmonary infection group and T2DM combined pulmonary infection group,respectively.The levels of blood immune indexes and inflammatory factors were compared among the three groups.After 6 months of follow-up,the prognosis and death of elderly patients with T2DM complicated with pulmonary infection were counted.According to whether death occurred,the patients were divided into death group and survival group,and the clinical data of the death group and the survival group were compared.Logistic multivariate regression analysis of related factors affecting the prognosis and death of elderly T2DM patients with pulmonary infection.Results The levels of CD4^(+)and CD4^(+)/CD8^(+)in T2DM group with pulmonary infection were lower than those in T2DM group and pulmonary infection group[(31.98±3.72)%vs(42.16±5.27)%vs(37.42±4.61)%,(0.81±0.15)vs(1.42±0.38)vs(1.13±0.21),F values were 61.09 and 66.60,both P values<0.05)].The levels CD8^(+),leukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C reactive protein(CRP)in T2DM patients with pulmonary infection were higher than those in T2DM group and pulmonary infection group[(40.06±4.06)%vs(30.43±3.65)%vs(33.21±3.52)%,(62.75±6.18)ng/mL vs(51.25±5.96)ng/mL vs(36.86±6.83)ng/mL,4.03±0.68)μg/mL vs(1.95±0.34)μg/mL vs(2.18±0.42)μg/mL,(13.27±4.86)mg/mL vs(4.15±1.27)mg/mL vs(7.25±2.05)mg/mL,F values were 87.32,42.27,68.32,89.61,all P values<0.05].The mortality rate of elderly T2DM patients with pulmonary infection was 15.32%(19/124).In the death group,the pulmonary infection caused by fungi,average blood glucose fluctuate range(MAGE),blood glucose standard deviation(SDBG),acute physiology and Chronic Health Score(APACHE)and CRP levels were higher than those in the survival group[26.32%vs 5.71%,(5.62±1.06)mmol/L vs(3.98±0.75)mmol/L,(3.28±0.92)mmol/L vs(2.45±0.56)mmol/L,(28.92±6.83)vs(24.36±5.65),(15.38±3.16)g/L vs(12.91±2.62)g/L,χ2/t values were 8.45,3.19,2.32,3.33,3.66,all P values<0.05],The ratio of CD4^(+)/CD8^(+)in death group was lower than that in survival group[(0.75±0.05)vs(0.82±0.07),t=4.16,P<0.05].Logistic regression results showed that APACHE score,CD4^(+)/CD8^(+)and CRP were all related factors affecting the death of elderly T2DM patients with pulmonary infection(OR=2.95,3.98,3.51,all P values<0.05).Conclusion There are abnormal blood immune indexes and inflammatory factors in elderly T2DM patients with pulmonary infection.APACHE score,CD4^(+)/CD8^(+)ratio and CRP are all influencing factors of death in elderly T2DM patients with pulmonary infection.Take countermeasures.