本文選題：T淋巴細胞亞群 + 流式細胞術　； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過綜合分析肺泡灌洗液(Bronchoalveolar lavage fluid BALF)及外周血T淋巴細胞亞群,旨在探討重癥細菌性肺炎患者肺組織局部及整體的免疫狀態(tài),并聯(lián)合PCT、PSI評分探討外周血T細胞亞群對于預測重癥肺炎的臨床價值。方法:收集2016年10月至2017年1月于天津醫(yī)科大學總醫(yī)院呼吸內科住院治療并診斷為社區(qū)獲得性細菌性肺炎患者63例,依診斷標準分為重癥肺炎(Severe pneumonia SP)組和非重癥肺炎(NSP)組,依PSI評分分為低危組、中危組、高危組三組。檢測外周血T細胞亞群、PCT、血常規(guī),BALF T細胞亞群、細胞分類。比較SP組與NSP組BALF與外周血T細胞各亞群水平、臨床特征差異。比較低危、中危、高危三組外周血T細胞各亞群水平、PCT、WBC水平;分析上述各指標與PSI評分之間的相關性及T細胞亞群對SP的預測能力。結果:本研究共納入細菌性肺炎患者63例,SP組17例,NSP組46例,兩組患者BALF T細胞亞群:SP組CD4+百分比、CD4+/CD8+小于NSP組,CD8+百分比大于NSP組,以上均無統(tǒng)計學差異;中性粒細胞(Neutrophil Neu)百分比SP組大于NSP組,差異具有統(tǒng)計學意義。兩組外周血T細胞亞群:SP組CD3+、CD4+百分比小于NSP組,CD8+百分比、CD4+/CD8+大于NSP組,以上均無統(tǒng)計學差異;SP組CD3+、CD4+、CD8+絕對值均小于NSP組,差異具有統(tǒng)計學意義。SP組患者年齡、PCT、WBC、PSI評分、腫瘤、心臟疾病、腦梗、肝病所占比例均明顯高于NSP組,而吸煙史、COPD、糖尿病、檢出菌株構成比兩組間無統(tǒng)計學差異。低危組、中危組、高危組三組患者CD3+、CD4+、CD8+絕對值均隨PSI評分嚴重程度的升高而降低,以上均具有統(tǒng)計學意義;CD3+、CD4+、CD8+百分比、CD4+/CD8+比值均無統(tǒng)計學差異。比較CD3+、CD4+、CD8+絕對值、PCT與PSI評分相關性:低危組上述指標與PSI評分均無明顯相關;中危組中上述指標與PSI評分均呈明顯負相關;高危組上述指標與PSI評分相關性更強;其中,中高危組CD3+絕對值相關性甚至高于PCT。以CD3+絕對值預測SCAP準確性可達中等水平(AUC=0.895 P0.0001),以0.46為標準,敏感性88.24%,特異性89.13%,僅次于PSI評分(AUC=0.955 P0.0001)。結論:SP患者肺組織局部以及整體的免疫狀態(tài)可能都存在一定程度的紊亂。年齡、腫瘤、心臟疾病、腦梗、肝病可能是造成其免疫功能低下的重要因素,而SP患者過度的炎癥反應可能也是造成淋巴細胞減少的原因。外周血T淋巴細胞亞群可能可以用于SP的預測,且百分比應用價值不及絕對值。
[Abstract]:Objective: to investigate the local and global immune status of lung tissue in patients with severe bacterial pneumonia by comprehensive analysis of bronchoalveolar lavage fluid BALFs and T lymphocyte subsets in peripheral blood of patients with severe bacterial pneumonia. The clinical value of peripheral blood T cell subsets in predicting severe pneumonia was also discussed in combination with PCT PSI score. Methods: from October 2016 to January 2017, 63 patients with community-acquired bacterial pneumonia were treated in Department of Respiratory Medicine, Tianjin Medical University General Hospital. According to the diagnostic criteria, 63 patients were divided into severe pneumonia pneumonia group and non-severe pneumonia group. According to PSI score, they were divided into three groups: low risk group, middle risk group and high risk group. The peripheral blood T cell subsets (PCT), BALF T cell subsets (BALF T cell subsets) and cell classification were detected. The levels and clinical characteristics of T cell subsets of BALF and peripheral blood in SP group and NSP group were compared. The level of peripheral blood T cell subsets and the correlation between the above indexes and PSI score and the prediction ability of T cell subsets to SP were analyzed. Results: a total of 63 patients with bacterial pneumonia were included in this study. There were 46 cases of BALF T cell subgroup (BALF T cell subsets) in 17 cases of NSP group. The percentage of CD4 CD4 / CD8 in the group of BALF T cell subsets was lower than that in group NSP (P < 0.01), and the percentage of CD8 in group C was higher than that in group NSP (P < 0.05). The percentage of neutrophil neutrophil in SP group was higher than that in NSP group. The percentage of CD4 / CD8 of peripheral blood T cell subsets in the two groups was lower than that in the NSP group. The ratio of CD4 / CD8 was higher than that in the NSP group. There was no statistical difference between the two groups. The absolute value of CD3 CD 4 / CD 8 in SP group was lower than that in NSP group. The difference was statistically significant. The age of the patients in SP group was significantly lower than that in the control group (P < 0.05). The proportion of heart disease, cerebral infarction and liver disease was significantly higher than that of NSP group, but there was no statistical difference between the two groups in smoking history and diabetes mellitus. The absolute value of CD3 CD4 / CD8 decreased with the increase of PSI score in low risk group, middle risk group and high risk group. There was no significant difference in the percentage of CD 4 / CD 8 and the ratio of CD 4 / CD 8. Comparing the absolute value of CD3 and CD 4, CD 8 and PSI score, the above indexes were not significantly correlated with PSI score in low risk group, the above indexes were negatively correlated with PSI score in middle risk group, the correlation between above indexes and PSI score was stronger in high risk group, among them, there was no significant correlation between above indexes and PSI score in low risk group, and there was significant correlation between above indexes and PSI score in high risk group. The absolute value correlation of CD3 in middle and high risk group was even higher than that in PCT. The accuracy of predicting SCAP by absolute value of CD3 was 0.895 P0.0001, and the sensitivity was 88.24 and the specificity was 89.13, second only to the PSI score of 0.955 P0.0001. The accuracy of predicting SCAP was 0.895 P0.0001, and the sensitivity was 88.24%, and the specificity was 89.13%, second only to that of PSI score (0.955 P0.0001). Conclusion there may be some disorder in the immune state of the lung tissue in patients with 1% SP. Age, tumor, heart disease, cerebral infarction, liver disease may be the important factors of low immune function, and the excessive inflammatory reaction in SP patients may also be the cause of lymphocytopenia. The T lymphocyte subsets in peripheral blood may be used to predict SP, and the application value of percentage is lower than that of absolute value.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.1

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