实用老年医学

实用老年医学 ›› 2025, Vol. 39 ›› Issue (3): 263-267.doi: 10.3969/j.issn.1003-9198.2025.03.011

• 临床研究 • 上一篇    下一篇

老年急性呼吸窘迫综合征病人早期免疫细胞动态变化与肺部感染的相关性研究

李国媛, 刘长英, 郝小丹, 成慧, 袁舒烜, 陈界宇, 王璋   

  1. 610083 四川省成都市,中国人民解放军西部战区总医院干部病房三科(李国媛,刘长英,郝小丹,袁舒烜,陈界宇,王璋);眼科(成慧)
  • 收稿日期:2024-04-15 出版日期:2025-03-20 发布日期:2025-04-03
  • 通讯作者: 王璋,Email:icuwz@Foxmail.com
  • 基金资助:
    四川省干部保健科研课题(川干研2021-1301)

Correlation between early dynamic changes of immune cells and pulmonary infection in elderly patients with acute respiratory distress syndrome

LI Guoyuan, LIU Changying, HAO Xiaodan, CHENG Hui, YUAN Shuxuan, CHEN Jieyu, WANG Zhang   

  1. The Third Department of Cadre Wards(LI Guoyuan, LIU Changying, HAO Xiaodan, YUAN Shuxuan, CHEN Jieyu, WANG Zhang); Department of Ophthalmology(CHENG Hui), General Hospital of the Western Theater Command of Chinese People's Liberation Army, Chengdu 610083,China
  • Received:2024-04-15 Online:2025-03-20 Published:2025-04-03
  • Contact: WANG Zhang, Email: icuwz@Foxmail.com

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摘要： 目的 研究老年急性呼吸窘迫综合征(ARDS)病人早期免疫细胞动态变化与肺部感染的相关性。 方法 选择2021年1月至2024年1月于中国人民解放军西部战区总医院住院治疗的113例老年ARDS病人为研究对象,根据病人是否发生肺部感染分为感染组(49例)和未感染组(64例)。比较2组一般资料和早期免疫细胞动态变化,采用多因素Logistic回归分析早期免疫细胞动态变化对老年ARDS病人肺部感染程度的影响。利用限制性立方样条模型分析病人早期免疫细胞动态变化与肺部感染的剂量-反应关系。 结果 2组间CRP、降钙素原(PCT)和WBC水平差异均有统计学意义(P<0.05)。与未感染组相比,感染组病人入院后6 h、第2天和第3天的CD3+ T细胞水平明显升高,CD4+、CD8+ T细胞水平和CD4+/CD8+比值均明显降低(P＜0.05)。有序多分类logistic回归分析结果显示,CD4+、CD8+T细胞水平和CD4+/CD8+的变化对老年ARDS病人肺部感染严重程度具有一定影响作用(P<0.05)。入院后6 h的CD3+、CD4+、CD8+ T细胞水平和CD4+/CD8+与老年ARDS病人肺部感染的关联呈非线性剂量-反应关系(Pnon-linearity=0.411、0.516、0.439、0.402)。 结论 老年ARDS病人早期免疫细胞动态变化与肺部感染密切相关,对病人肺部感染程度具有一定影响。

关键词: 老年人, 急性呼吸窘迫综合征, 免疫细胞, 肺部感染

Abstract: Objective To explore the correlation between early immune cell dynamics and pulmonary infection in the elderly patients with acute respiratory distress syndrome(ARDS). Methods A total of 113 elderly patients with ARDS who were hospitalized in General Hospital of the Western Theater Command of Chinese PLA from January 2021 to January 2024 were enrolled in this study. They were divided into the infected group(49 cases) and the uninfected group(64 cases) based on whether they presented with pulmonary infection. The general information and early immune cell dynamics between the two groups were compared. Multivariate Logistic regression was used to analyze the effect of early dynamic changes of immune cells on the severity of pulmonary infection in the elderly patients with ARDS. Restricted cubic spline model was used to analyze the dose-response relationship between early immune cell dynamics and lung infection. Results There were statistically significant differences in the levels of C-reactive protein(CRP), procalcitonin(PCT) and white blood cell(WBC) between the two groups(P<0.05). Compared with the uninfected group, the level of CD3+ T cells was significantly increased and the levels of CD4+, CD8+ T cells and CD4+/CD8+ ratio were significantly decreased in the infected group 6 h, 2 d and 3 d after admission(P<0.05). Ordinal logistic regression analysis showed that the changes of CD4+, CD8+ T cells and CD4+/CD8+ had a certain effect on the degree of pulmonary infection in the elderly patients with ARDS(P<0.05). The correlation of CD3+, CD4+, CD8+cell levels and CD4+/CD8+ 6 h after admission with pulmonary infection in the elderly ARDS patients showed a non-linear dose-response relationship(Pnon-linearity=0.411, 0.516, 0.439, 0.402). Conclusions The early dynamic changes of immune cells in the elderly ARDS patients are closely related to pulmonary infection, and it has a certain effect on the degree of pulmonary infection.

Key words: aged, acute respiratory distress syndrome, immune cells, pulmonary infection

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