老年肺炎患者的病原菌感染特征及细胞免疫功能研究

Study on the characteristics of pathogenic bacteria infection and cellular immune function in elderly patients with pneumonia

目的研究不同严重程度老年肺炎患者的临床特征及细胞免疫功能,以期为临床治疗提供依据。方法选取2019年1月~2023年12月期间在本院确诊为肺炎的老年患者225例,根据肺炎严重程度分为重症肺炎、非重症肺炎两组。收集并记录患者的临床资料,包括年龄、性别、基础疾病、临床表现、影像学检查结果、实验室检查结果等。采用流式细胞术检测患者外周血T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))及自然杀伤细胞(NK细胞)的百分比,评估细胞免疫功能。结果共检出病原菌225株,革兰阴性菌占68.89%,革兰阳性菌占27.56%,真菌占3.56%。革兰阴性菌中,铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、流感嗜血杆菌等占比分别为13.33%、11.56%、10.22%、9.33%和7.56%。革兰阳性菌中,肺炎链球菌、金黄色葡萄球菌、表皮葡萄球菌、屎肠球菌占比分别为12.44%、6.67%、5.33%和3.11%。真菌中,白色假丝酵母菌、热带假丝酵母菌占比分别为2.22%、1.33%。重症肺炎患者78例(34.67%),非重症肺炎患者147例(65.33%)。重症组中80.77%合并基础疾病,非重症组中68.03%合并基础疾病,差异显著(P<0.05)。重症组中82.05%出现咳嗽,非重症组中69.39%出现咳嗽,差异有统计学意义(P<0.05)。重症组中41.03%出现头晕头痛,非重症组中14.97%出现头晕头痛,差异有统计学意义(P<0.05)。重症组中38.46%出现横纹肌溶解,非重症组中2.04%出现横纹肌溶解,差异有统计学意义(P<0.05)。性别、吸烟史、饮酒史、发热、畏寒、胸闷、腹痛腹泻等症状占比差异无统计学意义(P>0.05)。重症肺炎组患者与非重症肺炎组患者在多肺叶、双侧肺部、各肺叶受累及支气管充气征占比差异有统计学意义(P<0.05),在实变影、磨玻璃影、淋巴结肿大占比差异无统计学意义(P>0.05)。重症肺炎组患者血清CD3^(+)、CD4^(+)、CD8^(+)、NK细胞活性水平显著低于非重症肺炎组和对照组(P<0.05)。结论老年肺炎患者病原菌主要为革兰阴性菌,以铜绿假单胞菌、肺炎克雷伯菌为主。不同严重程度的老年肺炎患者在临床特征及细胞免疫功能方面存在明显差异。重症肺炎患者较非重症肺炎患者更易合并基础疾病,且在临床表现上,重症患者咳嗽、头晕头痛及横纹肌溶解的发生率显著更高,在多肺叶、双侧肺部受累及支气管充气征方面与非重症肺炎患者有显著差异。重症肺炎患者的T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))及NK细胞活性水平显著低于非重症肺炎患者,这可能与重症患者体内免疫功能缺陷有关。

Objective To study the clinical characteristics and cellular immune function of elderly patients with pneumonia of different severities,in order to provide a basis for clinical treatment.MethodsA total of 225 elderly patients diagnosed with pneumonia in our hospital from January 2019 to December 2023 were selected and divided into two groups:severe pneumonia group and non-severe pneumonia group according to the severity of pneumonia.The clinical data of patients were collected and recorded,including age,gender,underlying diseases,clinical manifestations,imaging examination results,laboratory examination results,etc.Flow cytometry was used to detect the percentages of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and natural killer cells(NK cells)in peripheral blood of patients to evaluate cellular immune function.RIesults A total of 225 pathogenic bacteria were detected.Gram-negative bacteria accounted for 68.89%,Gram-positive bacteria accounted for 27.56%,and fungi accounted for 3.56%.Among Gram-negative bacteria,the proportions of Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,and Haemophilus influenzae were 13.33%,11.56%,10.22%,9.33%,and 7.56%,respectively.Among Gram-positive bacteria,the proportions of Streptococcus pneumoniae,Staphylococcus aureus,Staphylococcus epidermidis,and Enterococcus faecium were 12.44%,6.67%,5.33%,and 3.11%,respectively.Among fungi,the proportions of Candida albicans and C.tropicalis were 2.22%and 1.33%,respectively.There were 78 cases(34.67%)of severe pneumonia patients and 147 cases(65.33%)of non-severe pneumonia patients.In the severe group,80.77%had underlying diseases,and in the non-severe group,68.03%had underlying diseases,with a significant difference(P<0.05).In the severe group,82.05%had cough,and in the non-severe group,69.39%had cough,with a significant difference(P<0.05).In the severe group,41.03%had dizziness and headache,while in the non-severe group,14.97%had dizziness and headache,with a significant difference(P<0.05).In the severe group,38.46%had rhabdomyolysis,while in the nonsevere group,2.04%had rhabdomyolysis,with a significant difference(P<0.05).There were no significant differences in the proportions of symptoms such as gender,smoking history,drinking history,fever,chills,chest tightness,abdominal pain and diarrhea(P>0.05).There were significant differences in the proportions of multiple lobes,bilateral lungs,involvement of each lobe and air bronchogram between the severe pneumonia group and the non-severe pneumonia group(P<0.05),while there were no significant differences in the proportions of consolidation shadow,ground-glass shadow and lymph node enlargement(P>0.05).The activity levels of serum CD3^(+),CD4^(+),CD8^(+),and NK cells in patients in the severe pneumonia group were significantly lower than those in the non-severe pneumonia group and the control group(P<0.05).ConclusionThe pathogenic bacteria of elderly patients with pneumonia were mainly Gram-negative bacteria,mainly P aeruginosa and K pneumoniae.Elderly patients with pneumonia of different severities had obvious differences in clinical characteristics and cellular immune function.Patients with severe pneumonia were more likely to have underlying diseases than those with non-severe pneumonia.In terms of clinical manifestations,the incidence of cough,dizziness,headache and rhabdomyolysis in severe patients was significantly higher.There were significant differences from patients with non-severe pneumonia in terms of multiple lobes,bilateral lung involvement and air bronchogram.The activity levels of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and NK cells in patients with severe pneumonia were significantly lower than those in patients with non-severe pneumonia.This may be related to the immune function defect in the body of severe patients.