發(fā)布時(shí)間：2018-02-15 15:18

  本文關(guān)鍵詞： 卒中相關(guān)性肺炎 T淋巴細(xì)胞亞群 免疫抑制 病原菌　出處：《中國病原生物學(xué)雜志》2017年02期 　論文類型：期刊論文

【摘要】：目的分析卒中相關(guān)性肺炎(SAP)患者病原菌分布特征和T淋巴細(xì)胞亞群變化,探討其與細(xì)胞免疫功能的關(guān)系。方法選擇2014年12月至2016年9月在本院重癥監(jiān)護(hù)病房(ICU)住院治療的急性腦卒中患者95例�；颊呷朐汉蠹催M(jìn)行NIHSS評分,根據(jù)評分將入選患者分為重癥組(57例)和輕癥組(38例);根據(jù)入院后1~2周內(nèi)是否發(fā)生感染將患者分為SAP組(53例)和非SAP組(42例);選擇同期在本院體檢中心體檢的健康者40例作為對照組。根據(jù)痰培養(yǎng)結(jié)果分析SAP患者病原菌分布特征;檢測并比較各組受檢者T淋巴細(xì)胞亞群(CD3~+、CD4~+、CD4~+/CD8~+)變化,分析其與NIHSS評分的相關(guān)性。結(jié)果 SAP組NIHSS評分(15.3±5.4)分,與非SAP組(8.8±3.2)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。53例SAP患者共分離出病原菌81株,其中鮑曼不動(dòng)桿菌15株(18.5%),肺炎克雷伯菌12株(14.8%),金黃色葡萄球菌26株(32.1%),銅綠假單胞菌9株(11.1%),大腸埃希菌7株(8.6%),糞、屎腸球菌5株(6.2%),肺炎鏈球菌5株(6.2%),真菌2株(2.5%)。卒中患者CD3~+、CD4~+T淋巴細(xì)胞百分率及CD4~+/CD8~+比值均顯著低于對照組(P0.05),其中重癥組CD3+(61.20±5.29)%、CD4+(27.66±4.59)%、CD4~+/CD8~+值為0.91±0.46,輕癥組分別為(66.61±4.98)%、(33.70±4.95)%和1.23±0.57,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);SAP組CD3~+(62.24±4.87)%、CD4~+(30.59±5.26)%,CD4~+/CD8~+值為0.98±0.45,與非SAP組(64.64±4.49)%、(33.13±4.90)%和1.21±0.53比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);CD3~+、CD4~+T淋巴細(xì)胞百分率及CD4~+/CD8~+值均與NIHSS評分呈顯著負(fù)相關(guān)(r分別為-0.382、-0.521、-0.291,P_均0.05)。結(jié)論 SAP患者感染主要病原菌為革蘭陰性菌,SAP的發(fā)生與卒中患者細(xì)胞免疫功能受抑制有關(guān),且卒中病情越重,患者細(xì)胞免疫功能抑制越嚴(yán)重。
[Abstract]:Objective to analyze the distribution of pathogenic bacteria and the changes of T lymphocyte subsets in patients with stroke associated pneumonia (SAP). Methods from December 2014 to September 2016, 95 patients with acute stroke were treated in intensive care unit (ICU) of our hospital. The patients were assessed with NIHSS score immediately after admission. According to the score, the patients were divided into severe group (n = 57) and mild group (n = 38); according to whether infection occurred within 1 to 2 weeks after admission, the patients were divided into SAP group (n = 53) and non-#en1# group (n = 42). According to the results of sputum culture, the distribution characteristics of pathogenic bacteria in patients with SAP were analyzed. The changes of T lymphocyte subsets (CD3 ~ + CD4 ~ + CD4 ~ / CD8 ~) and their correlation with NIHSS score were detected and compared. Results the NIHSS score of SAP group was 15. 3 鹵5. 4%. 81 strains of pathogenic bacteria were isolated from 53 patients with SAP, compared with the control group (8.8 鹵3.2). Among them, Acinetobacter baumannii (15 strains), Klebsiella pneumoniae (12 strains), Staphylococcus aureus (26 strains), Pseudomonas aeruginosa (9 strains), Escherichia coli (7 strains), Escherichia coli (8. 6%), feces, Five strains of Enterococcus faecium, 5 strains of Streptococcus pneumoniae, 5 strains of Streptococcus pneumoniae, 2 strains of fungi and 2 strains of fungi showed that the percentage of CD4 ~ T lymphocytes and the ratio of CD4 ~ / -CD8 ~ ~ of CD4 ~% in stroke patients were significantly lower than those in the control group (P < 0.05). The CD8~ values of severe group were 61.20 鹵5.29 and 0.91 鹵0.46, respectively, and those of mild group were 33.70 鹵4.95% and 1.23 鹵0.57, respectively, and the difference was 0.91 鹵0.46, and that of mild group was 66.61 鹵4.983.70 鹵4.95% and 1.23 鹵0.57 respectively, and that of severe group was 0.91 鹵0.46, that of severe group was 66.61 鹵4.985.95% and 1.23 鹵0.57, respectively. There were significant differences in CD3 ~ T lymphocyte percentage and CD4- + -CD8- T lymphocyte percentage and CD4- + -CD8- T lymphocyte percentage and CD4- + -CD8- value between P0.05 and SAP group (P 0.05, P < 0. 05 鹵4. 26, P < 0. 05, r = 0. 382- 0. 521, P = 0. 05 and 0. 021 鹵0. 53, P < 0. 05 and P < 0. 05). Conclusion: the percentage of CD4 ~ T lymphocyte and the value of CD4 ~-CD8 ~ ~ in SAP group are negatively correlated with NIHSS score, respectively (r = -0. 382- 0. 521-0. 291P _ 0. 05) and 0. 05 鹵0. 05 鹵0. 05 鹵0. 05%, respectively. Conclusion there is a significant negative correlation between the percentage of CD4 ~ T lymphocytes and the value of CD4 ~ +-CD8 ~ + in SAP group. The main pathogen of SAP infection was Gram-negative bacteria. The occurrence of SAP was related to the inhibition of cellular immune function in patients with stroke. The more severe the stroke, the more serious the inhibition of cellular immune function.
【作者單位】： 鄭州大學(xué)附屬鄭州中心醫(yī)院重癥監(jiān)護(hù)室;
【分類號】：R743.3;R563.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 傅煜;符爽;陳芳;張繼紅;;淋巴細(xì)胞亞群在免疫相關(guān)疾病中的應(yīng)用[J];醫(yī)學(xué)綜述;2016年14期

2 鐘明媚;王t，

本文編號：1513566