發(fā)布時(shí)間：2018-04-10 09:32

  本文選題：多重耐藥鮑曼不動(dòng)桿菌　切入點(diǎn)：醫(yī)院獲得性肺炎　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討重癥監(jiān)護(hù)病房中多重耐藥鮑曼不動(dòng)桿菌(MDRAB)醫(yī)院獲得性肺炎(HAP)患者的免疫功能,各免疫指標(biāo)對(duì)醫(yī)院感染的預(yù)測(cè)價(jià)值及對(duì)預(yù)后的影響,以更好地指導(dǎo)臨床工作,降低患者的病死率。方法采用病例對(duì)照的研究方法,回顧性分析2011年6月一2016年6月廣西醫(yī)科大學(xué)第一附屬醫(yī)院MDRAB HAP 87例為觀察組,并選取同時(shí)期非MDRAB HAP 62例作為對(duì)照組,比較兩組患者T淋巴細(xì)胞、免疫球蛋白、NK細(xì)胞計(jì)數(shù)等免疫指標(biāo)及降鈣素原、C反應(yīng)蛋白、白細(xì)胞等炎性指標(biāo),觀察各免疫指標(biāo)及炎性指標(biāo)對(duì)醫(yī)院感染的預(yù)測(cè)作用。應(yīng)用t檢驗(yàn)進(jìn)行比較兩組中各免疫指標(biāo)及炎性指標(biāo)有無(wú)差異;將87例MDRAB HAP患者分為死亡組24例和存活組63例,應(yīng)用Logistic回歸分析MDRAB HAP死亡的預(yù)后因素。應(yīng)用ROC曲線評(píng)估各有統(tǒng)計(jì)學(xué)意義的指標(biāo)對(duì)醫(yī)院感染的預(yù)測(cè)價(jià)值。結(jié)果觀察組和對(duì)照組兩組患者性別、年齡等指標(biāo)無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),APACHE II評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)于免疫指標(biāo),兩組總T細(xì)胞、CD8+T淋巴細(xì)胞、免疫球蛋白M、免疫球蛋白G、NK細(xì)胞的比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(均P0.05),但兩組中CD4+T淋巴細(xì)胞、免疫球蛋白A的比較,差異均有統(tǒng)計(jì)學(xué)意義(均P0.05),繪制CD4+T淋巴細(xì)胞和免疫球蛋白A預(yù)測(cè)HAP的ROC曲線均具有較大診斷價(jià)值;炎性指標(biāo)的研究中,患者白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、降鈣素原、C反應(yīng)蛋白的比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(均P0.05)。針對(duì)CD4+T細(xì)胞、免疫球蛋白A繪制ROC曲線,其中CD4+T細(xì)胞的AUC值為0.608,敏感度為62.7%、特異度為57.5%;免疫球蛋白A的AUC值為0.637,敏感度為58.7%、特異度為76.4%,均有較大的預(yù)測(cè)價(jià)值。結(jié)論免疫指標(biāo)CD4+T細(xì)胞、免疫球蛋白A、APACHE II評(píng)分對(duì)指導(dǎo)重癥監(jiān)護(hù)病房中HAP患者的臨床治療有重要價(jià)值,對(duì)多重耐藥鮑曼不動(dòng)桿菌(MDRAB)醫(yī)院獲得性肺炎(HAP)患者的免疫功能及其預(yù)后的評(píng)估有具有重要意義。
[Abstract]:Objective to investigate the immune function of patients with multidrug resistant Acinetobacter baumannii (MDRAB) hospital acquired pneumonia (HAP) in intensive care unit (ICU), the predictive value of each immune index to nosocomial infection and its influence on prognosis, so as to guide the clinical work better.Reduce the mortality of patients.Methods A case-control study was conducted to retrospectively analyze 87 cases of MDRAB HAP in the first affiliated Hospital of Guangxi Medical University from June 2011 to June 2016, and 62 cases of non-#en2# HAP in the same period as control group.The immune indexes such as T lymphocyte, immunoglobulin NK cell count, procalcitonin C reactive protein, white blood cell and so on were compared between the two groups, and the predictive effect of each immune index and inflammatory index on nosocomial infection was observed.87 patients with MDRAB HAP were divided into death group (n = 24) and survival group (n = 63). Logistic regression analysis was used to analyze the prognostic factors of MDRAB HAP death.ROC curve was used to evaluate the predictive value of statistically significant indexes for nosocomial infection.Results there was no significant difference in gender, age and other indexes between the observation group and the control group. There was significant difference in Apache II score between the two groups (P 0.05).There was no significant difference in total T cell CD8 T lymphocytes, immunoglobulin M and immunoglobulin Gnk NK cells between the two groups (all P 0.05), but the comparison of CD4 T lymphocytes and immunoglobulin A between the two groups.The difference was statistically significant (all P0.05A, CD4 T lymphocytes and immunoglobulin A were used to predict the ROC curve of HAP.The difference of procalcitonin C-reactive protein was not statistically significant (P 0.05).The ROC curve of immunoglobulin A was drawn for CD4 T cells. The AUC value, sensitivity and specificity of CD4 T cells were 0.608, 62.7and 57.5, respectively, and the AUC value, sensitivity and specificity of immunoglobulin A were 0.637, 58.7 and 76.4, respectively.Conclusion the CD4 T cell and immunoglobulin A Apache II score have important value in guiding the clinical treatment of HAP patients in intensive care unit.It is of great significance to evaluate the immune function and prognosis of patients with multidrug resistant Acinetobacter baumannii MDRAB (Hospital acquired pneumonia).
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R563.1

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