结核重症监护室患者外周血CD4~+ T淋巴细胞的检测与临床意义
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摘要
目的探讨结核重症监护室(ICU)患者外周血CD4~+T淋巴细胞(简称CD4~+)的变化及意义,以判断患者的病情及预后。方法收集2015年3月—2016年8月我院ICU住院患者126例为观察组,并随机选取同期普通结核科住院患者62例为对照组,所有患者均于清晨空腹采集静脉血2 m L送检,采用流失细胞仪分别检测两组人员的外周血CD4~+T淋巴细胞数量;另将观察组按CD4~+检测水平分成低水平组(CD4~+<400 cell/ul)和正常水平组(CD4~+≥400 cell/ul);比较观察组和对照组CD4~+水平,并统计分析ICU不同CD4~+水平组患者的APACHII评分及预后等情况。结果观察组外周血CD4~+T淋巴细胞数量明显低于对照组(395. 33±242. 17 vs 635. 03±318. 78 cell/ul,P <0. 01); ICU低CD4~+水平组患者的APACHII评分(23. 40±5. 05 vs 20. 41±3. 55)及死亡率(66. 2%vs 15. 5%)均明显高于正常水平组,差异均有统计学意义(P <0. 01)。结论相比普通结核科患者而言,结核重症监护室患者机体细胞免疫功能更低;外周血CD4~+T淋巴细胞水平可协助判断患者的病情严重程度及预测死亡预后。
Objective To investigate the changes of CD4~+ lymphocyte in the peripheral blood and its clinical significance in the patients of tuberculosis intensive care unit( ICU). Methods 126 cases of ICU patients in our hospital from March 2015 to August 2016 were selected as the observation group,and 62 cases of normal hospitalized patients were randomly selected as the control group. All subjects received blood sampling by 2 ml with an empty belly in the morning. Peripheral blood CD4~+ lymphocytes were detected by flow cytometry. The observation group was divided into a lower level group with CD4~+< 400 cell/ul and normal group with CD4~+≥400 cell/ul. Compare the different groups and analyze the correlation with severity and prognosis of tuberculosis ICU patients. Results The count of peripheral blood CD4~+lymphocytes in the observation group was significantly lower than the control group( 395. 33 ± 242. 17 vs 635. 03 ± 318. 78 cell/ul,P < 0. 01); The Acute Physiology and Chronic Health Evaluation II( APACHE II) scores( 23. 40 ± 5. 05 vs 20. 41 ± 3. 55) and the mortality( 66. 2%vs 15. 5%) of the low CD4~+group were significantly higher than the normal CD4~+group( P < 0. 01). Conclusion Compared with the common tuberculosis patients,patients in tuberculosis ICU had more poor cellular immune function; the level of peripheral blood CD4~+lymphocytes can be used to make a judgment of severity and prognosis of tuberculosis ICU patients.
Objective To investigate the changes of CD4~+ lymphocyte in the peripheral blood and its clinical significance in the patients of tuberculosis intensive care unit( ICU). Methods 126 cases of ICU patients in our hospital from March 2015 to August 2016 were selected as the observation group,and 62 cases of normal hospitalized patients were randomly selected as the control group. All subjects received blood sampling by 2 ml with an empty belly in the morning. Peripheral blood CD4~+ lymphocytes were detected by flow cytometry. The observation group was divided into a lower level group with CD4~+< 400 cell/ul and normal group with CD4~+≥400 cell/ul. Compare the different groups and analyze the correlation with severity and prognosis of tuberculosis ICU patients. Results The count of peripheral blood CD4~+lymphocytes in the observation group was significantly lower than the control group( 395. 33 ± 242. 17 vs 635. 03 ± 318. 78 cell/ul,P < 0. 01); The Acute Physiology and Chronic Health Evaluation II( APACHE II) scores( 23. 40 ± 5. 05 vs 20. 41 ± 3. 55) and the mortality( 66. 2%vs 15. 5%) of the low CD4~+group were significantly higher than the normal CD4~+group( P < 0. 01). Conclusion Compared with the common tuberculosis patients,patients in tuberculosis ICU had more poor cellular immune function; the level of peripheral blood CD4~+lymphocytes can be used to make a judgment of severity and prognosis of tuberculosis ICU patients.
引文
[1] WORLD HEALTH ORGANIZATION. Global tuberculosis report2018[J]. Geneva:WHO,2018.
[2] GAIFER ZA. Risk factors for tuberculosis mortality in a tertiary care center in Oman,2006-2016[J]. Int J Mycobacteriol,2017,6(4):356-359.
[3] PECEQO AC,AMANCIORT,et al. Six-month survival of critically ill patients with HIV-related disease and tuberculosis:a retrospective study.[J]. BMC Infect Dis,2016,10(16):270.
[4]周芬,杨玉婷,华彦珺,等. CD4+T细胞对肺结核诊断的ROC曲线分析[J].中国卫生检验杂志,2015,25(19):3280-3282.
[5]黄丽静,陈焯彬,韦永孜,等.肺结核患者病情严重程度与免疫功能受损程度的相关性研究[J].海南医学,2016,27(9):1424-1426.
[6] ALEXANDER V. PANTELEEV,IRINA YU NIKITINA,et al.Severe tuberculosis in humans correlates best with neutrophil abundance and lymphocyte deficiency and does not correlate with antigen-specific CD4 T-cell response[J]. Front Immunol,2017,8:963.
[7]杨铭,袁平,吴怀戈,等.肺结核患者外周血T淋巴细胞亚群检测结果与病情的相关性研究[J].中国防痨杂志,2017,39(10):1093-1099.
[8]庞增,何日东,陈勇军,等.不同治疗时期肺结核患者T淋巴细胞亚群的动态变化及临床意义[J].现代医院,2018,186(4):82-84,89.
[9] ERBES,R. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care[J]. European Respiratory Journal,2006,27(6):1223-1228.
[10] MUTHU V,AGARWAL R,DHOORIA S,et al. Outcome of Critically Ill Subjects With Tuberculosis:Systematic Review and Meta-Analysis[J]. Respiratory Care,2018.
[11] BALKEMA CA,IRUSEN EM,TALJAARD JJ,et al. Tuberculosis in the intensive care unit:a prospective observational study[J]. Int J Tuberc Lung Dis,2014,18(7):824-830.
[12] WORLD HEALTH ORGANIZATION. Global tuberculosis report2017[J]. Geneva:WHO,2017.
[13]姚静静,孙强,谷战英.县级结核病定点医院医务人员离职意愿及影响因素分析[J].医学与社会,2018,31(5):55-57.
[2] GAIFER ZA. Risk factors for tuberculosis mortality in a tertiary care center in Oman,2006-2016[J]. Int J Mycobacteriol,2017,6(4):356-359.
[3] PECEQO AC,AMANCIORT,et al. Six-month survival of critically ill patients with HIV-related disease and tuberculosis:a retrospective study.[J]. BMC Infect Dis,2016,10(16):270.
[4]周芬,杨玉婷,华彦珺,等. CD4+T细胞对肺结核诊断的ROC曲线分析[J].中国卫生检验杂志,2015,25(19):3280-3282.
[5]黄丽静,陈焯彬,韦永孜,等.肺结核患者病情严重程度与免疫功能受损程度的相关性研究[J].海南医学,2016,27(9):1424-1426.
[6] ALEXANDER V. PANTELEEV,IRINA YU NIKITINA,et al.Severe tuberculosis in humans correlates best with neutrophil abundance and lymphocyte deficiency and does not correlate with antigen-specific CD4 T-cell response[J]. Front Immunol,2017,8:963.
[7]杨铭,袁平,吴怀戈,等.肺结核患者外周血T淋巴细胞亚群检测结果与病情的相关性研究[J].中国防痨杂志,2017,39(10):1093-1099.
[8]庞增,何日东,陈勇军,等.不同治疗时期肺结核患者T淋巴细胞亚群的动态变化及临床意义[J].现代医院,2018,186(4):82-84,89.
[9] ERBES,R. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care[J]. European Respiratory Journal,2006,27(6):1223-1228.
[10] MUTHU V,AGARWAL R,DHOORIA S,et al. Outcome of Critically Ill Subjects With Tuberculosis:Systematic Review and Meta-Analysis[J]. Respiratory Care,2018.
[11] BALKEMA CA,IRUSEN EM,TALJAARD JJ,et al. Tuberculosis in the intensive care unit:a prospective observational study[J]. Int J Tuberc Lung Dis,2014,18(7):824-830.
[12] WORLD HEALTH ORGANIZATION. Global tuberculosis report2017[J]. Geneva:WHO,2017.
[13]姚静静,孙强,谷战英.县级结核病定点医院医务人员离职意愿及影响因素分析[J].医学与社会,2018,31(5):55-57.