摘要
目的分析急性脑梗死(ACI)后肺部感染(PI)的危险因素及外周血CD_(4)^(+)T淋巴细胞表面程序性死亡因子1/程序性死亡因子1配体(PD-1/PD-L1)信号通路表达意义。方法选择2017年6月-2020年8月温州市中西医结合医院收治的125例ACI患者,根据是否发生PI分为感染组(n=31)和未感染组(n=94)。记录患者年龄、糖尿病、美国国立卫生研究院卒中量表(NIHSS)评分等临床特征。感染确诊后,流式细胞仪分析T淋巴细胞亚群水平和CD_(4)^(+)T淋巴细胞表面PD-1/PD-L1表达,酶联免疫吸附试验检测血清白介素(IL)-2、干扰素(IFN)-γ、IL-6、IL-10和肿瘤坏死因子-α(TNF-α)水平,记录两组住院时间和NIHSS评分减少率。Logistic回归分析影响ACI患者发生PI的危险因素。结果有糖尿病、侵入性操作和NIHSS评分≥10分均为影响ACI后PI的危险因素(P<0.05);感染组外周血CD_(4)^(+)T淋巴细胞和CD_(4)^(+)/CD_(8)^(+)T淋巴细胞比例低于未感染组(P<0.05),CD_(8)^(+)T细胞、CD_(4)^(+)PD-1和CD_(4)^(+)PD-L1比例高于未感染组(P<0.05),血清IL-2和IFN-γ水平低于未感染组(P<0.05),IL-6、IL-10和TNF-α水平高于未感染组(P<0.05);感染组患者住院时间长于未感染组,NIHSS减少率低于未感染组(P<0.05)。结论ACI后PI患者外周血CD_(4)^(+)PD-1和CD_(4)^(+)PD-L1升高,可以调节血清免疫炎症因子表达,影响患者预后,临床需重点关注合并糖尿病、侵入性操作和NIHSS评分≥10分的患者。
OBJECTIVE To analyze the risk factors of pulmonary infection(PI)after acute cerebral infarction(ACI)and the significance of the expression of programmed death factor 1/programmed death factor 1ligand(PD-1/PD-L1)signaling pathway on the surface of peripheral blood CD_(4)^(+)T lymphocytes and immune inflammatory cytokines.METHODS A total of 125ACI patients who were admitted to Wenzhou integrated traditional Chinese and Western Medicine Hospital from Jun 2017to Aug 2020were enrolled and divided into infection group(n=31)and non-infection group(n=94)according to the presence or absence of PI.The clinical characteristics such as age,diabetes,and National Institutes of Health Stroke Scale(NIHSS)score of patients were recorded.After the infection was confirmed,the levels of T lymphocyte subgroups and expression of PD-1/PD-L1in CD_(4)^(+)T lymphocytes were analyzed by flow cytometry,the serum interleukin(IL)-2,interferon(IFN)-γ,IL-6,IL-10and tumor necrosis factor-α(TNF-α)were detected by enzyme linked immunosorbent assay,and the length of hospital stay and the reduction rate of NIHSS score were recorded of the two groups.The influencing factors of PI in ACI patients were analyzed by Logistic regression analysis.RESULTS Diabetes mellitus(OR=2.056,P=0.021),invasive procedure(OR=2.117,P=0.015)and NIHSS score≥10(OR=1.984,P=0.034)were all risk factors affecting PI after ACI.The percentages of peripheral blood CD_(4)^(+)T and CD_(4)^(+)/CD_(8)^(+)T lymphocytes in infection group were significantly lower than those in non-infection group(P<0.05),while the percentages of CD_(8)^(+)T cells,CD_(4)^(+)PD-1and CD_(4)^(+)PD-L1were significantly higher than that in non-infection group(P<0.05).Serum IL-2and IFN-γwere significantly lower than those in non-infection group(P<0.05),and levels of IL-6,IL-10 and TNF-αwere significantly higher than those in non-infection group(P<0.05).The length of hospital stay in infection group was significantly longer than that in non-infection group(P<0.05),and the reduction rate of NIHSS was sign
作者
陈伟
凌艳
王永盛
CHEN Wei;LING Yan;WANG Yong-sheng(Wenzhou Integrated Traditional Chinese and Western Medicine Hospital,Wenzhou,Zhejiang 325000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第23期3537-3541,共5页
Chinese Journal of Nosocomiology
基金
浙江省科学技术研究与发展基金资助项目(201806A130)
