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| 外周血CD4+CXCR5+Tfh水平对肺炎克雷伯菌感染者预后的影响 |
| Effect of peripheral blood CD4+CXCR5+Tfh cell level on prognosis of patients with Klebsiella pneumoniae infection |
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| DOI：10.3969/j.issn.1007-8134.2021.04.010 |
| 中文关键词: 肺炎克雷伯菌 感染 外周血 滤泡辅助性T细胞 ICU 入住ICU时APACHE II评分 危险因素 预后 |
| 英文关键词: Klebsiella pneumoniae infection peripheral blood T follicular helper cell ICU APACHE II score at ICU admission risk factor prognosis |
| 基金项目:青海省重点研发与转化计划项目（2017-SF-122） |
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| 中文摘要: |
| 目的 检测肺炎克雷伯菌感染者外周血CD4+CXCR5+滤泡辅助性T细胞（T follicular helper cell, Tfh）水平，探讨其对患者预后的影响。方法 选取2017年7月—2019年5月于本院ICU住院治疗的147例患者为研究对象，根据患者入院后是否出现肺炎克雷伯菌感染，将其分为感染组（69例）和未感染组（78例）。采用流式细胞术检测147例患者外周血CD4+CXCR5+Tfh水平。采用单因素分析肺炎克雷伯菌感染的影响因素；采用单因素分析和多因素Logistic回归分析肺炎克雷伯菌感染者预后的影响因素。结果 感染组的住院时间、入住ICU时间、入住ICU时APACHE II评分、机械通气时间及心血管疾病、多器官功能障碍综合征、接受手术、恶性肿瘤患者比例均高于未感染组，差异均有统计学意义（P均＜0.05）。感染组外周血CD4+CXCR5+Tfh水平、死亡患者比例均高于未感染组（P均＜0.05）。感染组中死亡患者外周血CD4+CXCR5+Tfh水平高于生存患者（P＜0.05）。CD4+CXCR5+Tfh、碳青霉烯类耐药、入住ICU时APACHE II评分是影响肺炎克雷伯菌感染者死亡的独立危险因素（P均＜0.05）。结论 外周血CD4+CXCR5+Tfh水平在肺炎克雷伯菌感染者中显著升高，CD4+CXCR5+Tfh可能通过参与机体免疫应答影响感染者的预后。检测CD4+CXCR5+Tfh水平不仅对判断感染者的免疫状态有重要意义，也可为肺炎克雷伯菌感染者治疗提供依据。 |
| 英文摘要: |
| Objective To detect the level of peripheral blood CD4+CXCR5+ follicular helper T (Tfh) cells in patients with Klebsiella pneumoniae infection, and to explore the influence of its level on the prognosis of patients. Methods A total of 147 patients hospitalized in the ICU of our hospital from July 2017 to May 2019 were selected as the research objects, according to the presence or absence of Klebsiella pneumoniae infection, these patients were divided into infection group (n=69) and non-infection group (n=78). The level of CD4+CXCR5+Tfh cells in peripheral blood of 147 patients was detected by flow cytometry. The factors influencing Klebsiella pneumoniae infection were analyzed by univariate analysis. The factors affecting the prognosis of patients with Klebsiella pneumoniae infection were analyzed by univariate analysis and multivariate Logistic regression. Results The hospitalization time, ICU stay, APACHE II score at ICU admission, mechanical ventilation time, cardiovascular disease, multiple organ dysfunction syndrome (MODS), surgery time and percentage of malignant tumor patients in the infection group were higher than those in the non-infection group, with significant differences (P＜0.05). The levels of CD4+CXCR5+Tfh cells in peripheral blood and proportion of deaths in the infection group were higher than those in the non-infection group (P＜0.05). The level of CD4+CXCR5+Tfh cells in peripheral blood of the dead patients of infection group was higher than that in the survival patients of infection group (P＜0.05). CD4+CXCR5+Tfh, carbapenem resistance and APACHE II score at ICU admission were independent risk factors for the death of patients with Klebsiella pneumoniae infection (P＜ 0.05). Conclusions The level of CD4+CXCR5+Tfh in peripheral blood increases significantly in patients with Klebsiella pneumoniae infection. CD4+CXCR5+Tfh cells may affect the prognosis of patients with Klebsiella pneumoniae infection by participating in immune response. Detection of CD4+CXCR5+Tfh level is of great significance in judging the immune status of infected patients, also provides the basis for the treatment of Klebsiella pneumoniae infection. |
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