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目的研究免疫状态在呼吸机相关性肺炎(VAP)发生机制中的作用。方法对58例无肺部感染行机械通气的患者入科时、48h和1周行血清瘦素、CD4+及CD8+T细胞、淋巴细胞计数的检测,并对患者行临床肺部感染评分(CPIS)和序贯器官衰竭(SOFA)评分。结果 58例患者中发生VAP 23例,为VAP组,非VAP患者35例,为NVAP组;两组患者在入科时血清瘦素水平差异无统计学意义,其中,VAP组患者血清瘦素水平在机械通气48h和1周分别为(3.735±0.445)、(3.727±0.393)pg/ml,NVAP组血清瘦素水平在机械通气48h和1周分别为(3.469±0.393)、(3.485±0.355)pg/ml,VAP组血清瘦素水平均高于NVAP组(P<0.05);VAP组CD8+T细胞在机械通气1周时为(27.00±5.92)%,NVAP组CD8+T细胞在机械通气1周时为(23.89±5.45)%,VAP组CD8+T细胞在机械通气1周时高于NVAP组(P<0.05);VAP组患者淋巴细胞计数在1周时低于NVAP组(P<0.05);VAP组CPIS评分和SOFA评分在1周时高于NVAP组(P<0.05)。结论血清瘦素水平升高易发生VAP;其机制可能与其介导细胞免疫低下有关。
Objective To study the role of immune status in the pathogenesis of ventilator-associated pneumonia (VAP). Methods Serum leptin, CD4 + and CD8 + T cells and lymphocyte counts were measured in 58 patients with mechanical ventilation without pulmonary infection at 48h and 1 week. The clinical pulmonary infection score (CPIS ) And sequential organ failure (SOFA) scores. Results Among the 58 patients, 23 cases were VAP, 35 cases were VAP, 35 cases were non-VAP and NVAP. There was no significant difference in serum leptin levels between the two groups. Serum leptin level (3.735 ± 0.445) and (3.727 ± 0.393) pg / ml at48h and1weeks after mechanical ventilation, respectively.The levels of serum leptin in NVAP group were (3.469 ± 0.393), (3.485 ± 0.355) and (P <0.05). The level of CD8 + T cells in VAP group was (27.00 ± 5.92)% at 1 week after mechanical ventilation, and the level of CD8 + T cells in NVAP group was lower than that of NVAP group The number of CD8 + T cells in VAP group was higher than that in NVAP group at 1 week of mechanical ventilation (P <0.05). The number of lymphocyte in VAP group was lower than that of NVAP group at 1 week (P < 0.05). The CPIS score and SOFA score in VAP group were higher than those in NVAP group at 1 week (P <0.05). Conclusions High serum leptin level is prone to VAP; its mechanism may be related to its low cellular immunity.