摘要
目的探讨老年社区获得性肺炎(CAP)并脓毒症患者血清sCD14和外周血单核细胞CD14+/HLA-DR表达水平及临床意义。方法选取2015年1月~2018年12月我院呼吸内科及ICU收治的老年CAP患者126例,根据是否并发脓毒症将老年CAP患者分为脓毒症组56例,非脓毒症组70例,另选择老年健康体检者45例为对照组,脓毒症组根据是否存活分为死亡组30例及存活组26例。采用ELISA法和流式细胞术检测并比较各组血清sCD14及外周血单核细胞CD14+/HLA-DR+表达水平,脓毒症组及非脓毒症组48 h CURB-65评分、28 d死亡率。结果脓毒症组血清sCD14水平高于非脓毒症组和对照组,而CD14+/HLA-DR+表达水平则低于非脓毒症组和对照组,差异均有统计学意义(P<0.05)。死亡组血清sCD14水平高于存活组,CD14+/HLA-DR表达水平低于死亡组,差异有统计学意义(P<0.05);相关分析显示,血清sCD14水平与CURB-65评分和28 d死亡率呈正相关(r=0.750、0.712,P<0.05),而与CD14+/HLA-DR呈负相关(r=-0.692,P<0.05),CD14+/HLA-DR与CURB-65评分和28 d死亡率呈负相关(r=-0.653、-0.721,P<0.05)。结论老年社区获得性肺炎并脓毒症患者存在免疫失衡,血清sCD14和CD14+/HLA-DR表达水平与CURB-65评分和28 d死亡率密切相关,可作为早期预测感染性疾病病情严重程度和预后的免疫学指标。
Objective To investigate the expression levels and clinical significance of sCD14 and peripheral blood mononuclear cells CD14+/HLA-DR in elderly patients with community acquired pneumonia(CAP)and sepsis.Methods From January 2015 to December 2018,126 elderly CAP patients admitted to our hospital's Department of Respiratory Medicine and ICU were selected.According to the presence or absence of sepsis,elderly CAP patients were divided into 56 cases of sepsis and 70 cases of non-septic In addition,45 elderly healthy people were selected as the control group.ELISA and flow cytometry were used to detect and compare the serum sCD14 and CD14+/HLA-DR+expression levels of serum sCD14 and peripheral blood mononuclear cells in each group,48h CURB-65 score,and 28d mortality in sepsis and non-septic groups.Sepsis group was divided into 30 cases of death group and 26 cases of survival group according to survival.Results The serum sCD14 level in the sepsis group was higher than that in the non-septic group and the control group,while the expression level of CD14+/HLA-DR+was lower than that in the non-septic group and the control group,the differences were statistically significant(P<0.05).The serum sCD14 level in the death group was higher than that in the survival group,and the expression level of CD14+/HLA-DR was lower than that in the death group,the difference was statistically significant(P<0.05).Correlation analysis showed that serum sCD14 level was positively correlated with CURB-65 score and mortality(r=0.750,0.712,P<0.05),but negatively correlated with CD14+/HLA-DR(r=-0.692,P<0.05),CD14+/HLA-DR was negatively correlated with CURB-65 score and mortality(r=-0.653,-0.721,P<0.05).Conclusion Immunological imbalance exists in elderly patients with communityacquired pneumonia and sepsis.Serum sCD14 and CD14+/HLA-DR expression levels are closely related to CURB-65 scores and mortality,which can be used as an early predictor of the severity and prognosis of infectious diseases index.
作者
石玉英
段训新
黄龙
SHI Yu-ying;DUAN Xun-xin;HUANG Long(Department of Laboratory Medicine,the Affiliated Hospital of Jiujiang University,Jiujiang 332000,Jiangxi,China)
出处
《医学信息》
2020年第2期86-88,共3页
Journal of Medical Information
作者简介
石玉英(1991.11-),女,江西九江人,本科,主管技师,主要从事临床检验工作。
