免疫因素对于危重型H1N1流感肺炎患儿有创机械通气的预测价值

Predictive value of immune factors for invasive mechanical ventilation in critically ill children with H1N1 influenza pneumonia

目的总结不同通气方式下危重型H1N1流感肺炎患儿的临床特征,并探讨其机体免疫与最终通气方式的相关性。方法回顾性分析2017年1月至2019年12月河北省儿童医院收治的108例危重型流感肺炎患儿资料,根据呼吸支持方式不同,分为无创通气组和有创通气组,比较2组间临床资料、炎性指标及免疫功能。结果有创通气组入院三天后合并细菌感染率为33.3%,均为鲍曼不动杆菌,显著高于无创组(P<0.05)。两组均呈现获得性的免疫紊乱,CD3^(+)T、CD4^(+)T、CD8^(+)T细胞占比,均明显低于正常值。其中CD8^(+)T细胞比例在有创组显著低于无创组(P<0.05)。有创组IL-6均值为29.331高于无创组(P<0.05),但白细胞、C反应蛋白、降钙素原无差异;ROC曲线分析提示白细胞介素-6和CD8^(+)T对有创机械通气有一定提示作用,其截断值分别为17.96pg/mL(敏感度76.3%、特异度72.5%)和15.21%(敏感度74.8%、特异度74.2%);结论危重型H1N1流感肺炎患儿有创通气者比无创辅助通气者免疫力更差,且白细胞介素-6和CD8^(+)T对有创机械通气有一定预测价值。

Objective To summarize the clinical characteristics of children with severe H1N1 influenza pneumonia under different ventilation methods,and to explore the correlation between their immunity and the final ventilation mode.Methods The data of 108 children with severe influenza pneumonia admitted to Hebei Children′s Hospital from January 2017 to December 2019 were retrospectively analyzed.According to different respiratory support methods,they were divided into non-invasive ventilation group and invasive ventilation group.The clinical data,inflammatory indexes,and immune function were compared between the two groups.Results The combined bacterial infection rate in the invasive ventilation group three days after admission was 33.3%,all of which were Acinetobacter baumannii,which was significantly higher than that in the non-invasive group(P<0.05).Both groups showed acquired immune disorders,and the proportions of CD3^(+)T,CD4^(+)T,and CD8^(+)T cells were significantly lower than normal.The proportion of CD8^(+)T cells in the invasive group was significantly lower than that in the non-invasive group(P<0.05).The mean value of IL-6 in the invasive group was 29.331,which was higher than that in the non-invasive group(P<0.05),but there was no difference in leukocytes,C-reactive protein,and procalcitonin;Mechanical ventilation has a certain prompting effect,and the cut-off values were 17.96 pg/mL(sensitivity 76.3%,specificity 72.5%)and 15.21%(sensitivity 74.8%,specificity 74.2%).Conclusion Children with severe H1N1 influenza pneumonia who received invasive ventilation had worse immunity than those who received non-invasive assisted ventilation,and IL-6 and CD8^(+)T had certain predictive values for invasive mechanical ventilation.