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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

40卷

期数:

2023年5

页码:

432-436

栏目:

临床研究

出版日期:

2023-05-05

文章信息/Info

Title:

Predictive value of peripheral blood CD4⁺/CD8⁺,procalcitonin and C-reactive protein levels on the prognosis of elderly patients with ventilator-associated pneumonia

作者:

武俊慧; 柴海强; 乔廉洁; 樊建勇

（西安国际医学中心医院胸科医院呼吸科，陕西　西安　710100）

Author(s):

WU Junhui; CHAI Haiqiang; QIAO Lianjie; FAN Jianyong

(Department of Respiratory Diseases,Chest Hospital,Xi′an International Medical Center Hospital,Xi′an 710100,Shaanxi Province,China)

关键词:

呼吸机相关性肺炎; CD4⁺/CD8⁺; 降钙素原; C反应蛋白; 危险因素

Keywords:

ventilator-associated pneumonia; CD4⁺/CD8⁺; procalcitonin; C-reactive protein; risk factor

分类号:

R651

DOI:

10.7683/xxyxyxb.2023.05.006

文献标志码:

A

摘要:

目的　探讨外周血CD4⁺/CD8⁺、降钙素原（PCT）和C反应蛋白（CRP）水平对老年呼吸机相关性肺炎（VAP）患者预后的预测价值。
方法　选择2019年9月至2020年10月西安国际医学中心医院胸科医院收治的93例老年VAP患者为VAP组，另选择同期体检健康者86例为对照组。VAP患者于确诊后第2天、对照组受试者于体检当日检测外周血中T淋巴细胞亚群及PCT、CRP水平，并计算CD4⁺/CD8⁺值；所有VAP患者确诊后随访28 d，统计VAP组患者的病死率；通过查阅病历采集VAP患者的临床资料，对VAP患者死亡的影响因素进行单因素分析，采用logistic回归模型分析VAP患者死亡的危险因素，采用受试者操作特征（ROC）曲线分析外周血CD4⁺/CD8⁺、PCT、CRP水平对老年VAP患者预后的预测价值。
结果　VAP组患者的外周血CD4⁺/CD8⁺水平显著低于对照组，PCT、CRP水平显著高于对照组（P<0.05）。随访28 d内，93例VAP患者中，存活65例（存活组），死亡28例（死亡组），病死率为30.11%（28/93）。死亡组患者的外周血CD4⁺/CD8⁺水平显著低于存活组，PCT、CRP水平显著高于存活组（P<0.05）。单因素分析结果显示，昏迷、急性生理与慢性健康评估评分Ⅱ（APACHEⅡ）评分与VAP患者死亡有关（P<0.05），性别、年龄、吸烟史、饮酒史、合并症、慢性肺疾病、胃反流、使用制酸剂、留置胃管、气管切开、白蛋白水平、血糖、机械通气时间及住院时间与VAP患者死亡无关（P>0.05）。Logistic回归分析结果显示，APACHEⅡ评分及外周血PCT、CRP水平是老年VAP患者死亡的独立危险因素（P<0.05），外周血CD4⁺/CD8⁺是老年VAP患者死亡的保护因素（P<0.05）。ROC曲线分析显示，外周血CD4⁺/CD8⁺、PCT、CRP水平预测老年VAP患者死亡的最佳截断点分别为0.881、1.403 μg·L^-1、0.682 mg·L^-1，灵敏度分别为85.71%、89.29%、82.14%，特异度分别为92.31%、81.54%、96.92%，曲线下面积分别为0.953、0.848、0.872。
结论　老年VAP患者病死率较高，外周血PCT、CRP水平是老年VAP患者死亡的独立危险因素，外周血CD4⁺/CD8⁺是老年VAP患者死亡的保护因素，外周血CD4⁺/CD8⁺、PCT、CRP对老年VAP患者的预后具有一定的预测价值。

Abstract:

Objective　To investigate the predictive value of peripheral blood CD4⁺/CD8⁺,procalcitonin (PCT) and C-reactive protein (CRP) levels on the prognosis of elderly patients with ventilator-associated pneumonia (VAP).
Methods　Ninety-three elderly patients with VAP admitted to the Chest Hospital of Xi′an International Medical Center Hospital from September 2019 to October 2020 were selected as the VAP group,and eighty-six healthy individuals who underwent physical examination during the same period were selected as the control group.The levels of T lymphocyte,PCT and CRP in peripheral blood were detected in VAP patients on the second day after final diagnosis and healthy individuals in the control group on the day of physical examination,and the ratio of CD4⁺/CD8⁺ was calculated.All VAP patients were followed up for 28 days after diagnosis,and the mortality rate of patients in the VAP group was calculated.The clinical data of VAP patients were collected by reviewing medical records.The influencing factors of death of VAP patients were analyzed by univariate analysis.The risk factors of death of VAP patients were analyzed by logistic regression model,and the predictive value of peripheral blood CD4⁺/CD8⁺,PCT and CRP levels on the prognosis of elderly VAP patients was analyzed by receiver operating characteristic (ROC) curve.
Results　The peripheral blood CD4⁺/CD8⁺ level of patients in the VAP group was significantly lower than that in the control group,and the levels of serum PCT and CRP were significantly higher than those in the control group (P<0.05).Within 28 days of follow-up,among the 93 VAP patients,65 survived (survival group) and 28 died (death group),the mortality rate was 30.11% (28/93).The peripheral blood CD4⁺/CD8⁺ level of patients in the death group was significantly lower than that in the survival group,and the levels of PCT and CRP were significantly higher than those in the survial group (P<0.05).The results of univariate analysis showed that the coma,acute physiology and chronic health evaluation score Ⅱ(APACHE Ⅱ) score were related to the death of VAP patients (P<0.05),while the gender,age,smoking history,drinking history,comorbidities,chronic lung disease,gastric regurgitation,using antacids,indwelling gastric tube,tracheotomy,albumin level,blood glucose,mechanical ventilation time and hospitalization time were not related to the death of VAP patients(P>0.05).The results of logistic regression analysis showed that the APACHE Ⅱ score,peripheral blood PCT and CRP levels were the independent risk factors for death of elderly VAP patients (P<0.05),while the peripheral blood CD4⁺/CD8⁺ was a protective factor for death of elderly VAP patients (P<0.05).The ROC curve analysis showed that the optimal cutoff values of peripheral blood CD4⁺/CD8⁺,PCT and CRP levels for predicting death in elderly VAP patients were 0.881,1.403 μg·L^-1 and 0.682 mg·L^-1,respectively;the sensitivity was 85.71%,89.29% and 82.14%,respectively;the specificity was 92.31%,81.54% and 96.92%,respectively;the area under curve was 0.953,0.848,and 0.872,respectively.
Conclusion　The mortality rate of elderly patients with VAP is high.The peripheral blood PCT and CRP levels are independent risk factors for the death of elderly VAP patients,while the peripheral blood CD4⁺/CD8⁺ is a protective factor for the death of elderly VAP patients.The peripheral blood CD4⁺/CD8⁺,PCT and CRP have certain predictive value for the prognosis of elderly VAP patients.

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更新日期/Last Update: 2023-05-05