脑卒中患者免疫功能与卒中相关性肺炎严重程度的关系及临床意义

doi:10.19854/j.cnki.1008-2425.2022.05.0009

摘要/Abstract

摘要： 目的探讨急性脑卒中患者免疫功能与卒中相关性肺炎严重程度的关系,并分析免疫功能对继发多重耐药菌(MDR)感染的影响。方法回顾性分析中国科技大学附属第一医院神经重症2019年12月至2022年3月收治的101例卒中相关性肺炎患者的临床资料,根据肺炎严重程度指数评分将其分为轻度(33例)、中度(39例)、重度(29例)三组,另纳入30例未合并肺炎的急性脑卒中患者作为对照。对比分析各组间外周血CD4+T、CD8+T、CD4+T/CD8+T、淋巴细胞计数、肺泡灌洗液中HLA-DR的差异及与MDR感染的相关性。结果组间对比分析显示,中、重度肺炎组淋巴细胞计数、CD4+T、CD4+T/CD8+T低于对照组、CD8+T高于对照组,差异存在统计学意义(P＜0.05);重度组肺泡灌洗液中HLA-DR较轻、中度组阳性率降低,差异有统计学意义(P＜0.05);中、重度组患者MDR发生率高于轻度组,差异有统计学意义(P＜0.05);MDR组与非MDR组对比显示其CD4+T、CD4+T/CD8+T及淋巴细胞计数更低,而CD8+T更高,差异有统计学意义(P＜0.05)。结论卒中相关性肺炎患者存在不同程度免疫功能异常,免疫功能越差,卒中后肺炎越重,且越易合并多重耐药菌感染。

Abstract: Objective To investigate the relationship between immune function and the severity of stroke-associated pneumonia in patients with stroke,and to analyze the effect of immune function on secondary multidrug-resistant bacteria infection.Methods The clinical data of 101 patients with stroke-related pneumonia admitted to the First Affiliated Hospital of University of Science and Technology of China from December 2019 to March 2022 were retrospectively analyzed.According to the pneumonia severity index score,the patients were divided into mild(33 cases),moderate(39 cases) and severe(29 cases) groups.Thirty patients with acute stroke without pneumonia were selected as control.The differences of CD4+T,CD8+T,CD4+T/CD8+T in peripheral blood,lymphocyte count,and HLA-DR in alveolar lavage fluid between groups were compared and analyzed,and the correlation with MDR infection was also analyzed.Results Comparison analysis between groups showed that the lymphocyte count,CD4+T,CD4+T/CD8+T of moderate and severe pneumonia group were lower than those of the control group,and CD8+T was higher than that of the control group,and the differences were statistically significant(P＜0.05).The positive rate of HLA-DR in the severe group was significantly lower than that in the mild and moderate groups(P＜0.05).The incidence of MDR in moderate and severe groups was higher than that in mild group,and the difference was statistically significant(P＜0.05).Compared with non-MDR group,CD4+T,CD4+T/CD8+T and lymphocyte count of MDR group were lower,while CD8+T was higher,and the difference was statistically significant(P＜0.05).Conclusion Patients with stroke-associated pneumonia have different degrees of immune dysfunction.The worse the immune function,the more severe the pneumonia after stroke,and the more likely it is to be complicated with multi-drug resistant bacteria infection.

Key words: Stroke-associated pneumonia, CD4, CD8, HLA-DR, Multiple drug resistant bacteria

中图分类号:

R743.3

牛玉梅, 汤睿, 周敏. 脑卒中患者免疫功能与卒中相关性肺炎严重程度的关系及临床意义[J]. 立体定向和功能性神经外科杂志, 2022, 35(5): 301-305.

Niu Yumei, Tang Rui, Zhou Min. Relationship between immune function and the severity of stroke-associated pneumonia and its clinical significance[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(5): 301-305.

参考文献

[1] Koennecke HC,Belz W,Berfelde D,et al.Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit[J].Neurology,2011,77(10):965～972.
[2] Hoffmann S,Harms H,Ulm L,et al.Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia-The PREDICT study[J].J Cereb Blood Flow Metab,2017,37(12):3671～3682.
[3] Liu D D,Chu S F,Chen C,et al.Research progress in stroke-induced immunodepression syndrome(SIDS) and stroke-associated pneumonia(SAP)[J].Neurochem Int,2018,114:42～54.
[4] Faura,Bustamante A,Francesc Miró-Mur,et al.Stroke-induced immunosuppression:implications for the prevention and prediction of post-stroke infections[J].J Neuroinflammation,2021,18(1):127.
[5] Zhang DP,Yan FL,Xu HQ,et al.A decrease of human leucocyte antigen-DR expression on monocytes in peripheral blood predicts stroke-associated infection in critically-ill patients with acute stroke[J].Eur J Neurol,2010,16(4):498～505.
[6] 张帅,韩芳,林蕊艳,等.CRP及PSI评分在社区获得性肺炎中的应用价值[J].临床肺科杂志,2011,16(6):821～822.
[7] 何哲.血清ApoE,PCT和BNP水平与重症监护室HAP患者病情严重程度的相关性[J].中国民康医学,2021,33(20):12～14.
[8] 张新颜,闫福岭,邵伟波,等.检测单核细胞HLA-DR和T淋巴细胞亚群变化对脑卒中相关性肺炎的预测价值[J].中国神经免疫学和神经病学杂志,2013,20(6):396～399.
[9] 林萍,付金霞,张贺男,等.脑卒中并发肺炎患者病原菌、危险因素及T淋巴细胞水平分析[J].中国病原生物学杂志,2019,14(7):826～829.
[10] Snauwaert S,Verstichel G,Bonte S,et al.In vitro generation of mature,naive antigen-specific CD8(+) T cells with a single T-cell receptor by agonist selection[J].Leukemia,2014,28(4):830～841.
[11] 李琳,刘玮,洪畋,等.卒中相关性肺炎血清炎症因子和外周血淋巴细胞亚群的分析[J].中国临床神经外科杂志,2019,24(12):740～742.
[12] Zhuang Y,Peng H,Chen Y,et al.Dynamic monitoring of monocyte HLA-DR expression for the diagnosis,prognosis,and prediction of sepsis[J].Front Biosci,2017,22(8):1344～1354.
[13] Suzuki E,Tsukada H,Ishida T,et al.Correlation between the numbers of gammadelta T cells and CD4+ HLA-DR+ T cells in broncho-alveolar lavage fluid from patients with diffuse lung disease.[J].Tohoku J Exp Med,2002,196(4):231～240.
[14] Peter J,Frey O,Stallmach A,et al.Attenuated antigen-specific T cell responses in cirrhosis are accompanied by elevated serum interleukin-10 levels and down-regulation of HLA-DR on monocytes[J].BMC Gastroenterol,2013,13(1):1～10.
[15] Zhuang Y,Li W,Wang H,Peng H,Chen Y,Zhang X,Chen Y,Gao C.Predicting the Outcomes of Subjects With Severe Community-Acquired Pneumonia Using Monocyte Human Leukocyte Antigen-DR[J].Respir Care,2015,60(11):1635～1642.
[16] 舒本富,罗焱梅,赵安,等.老年卒中相关性肺炎发生多重耐药菌感染的危险因素分析[J].实验与检验医学,2015,33(6):805～808.
[17] Zhang D,Ren J,Luo Y,et al.T Cell Response in Ischemic Stroke:From Mechanisms to Translational Insights[J].Front Immunol,2021,12:707972.