凝血功能及机体免疫功能与肺炎严重程度的相关性分析

doi:10.3760/cma.j.issn.1007-1245.2023.15.008

摘要/Abstract

摘要：

目的　探讨凝血功能、细胞因子、淋巴细胞亚群与肺炎严重程度的相关性，为临床评估肺炎感染的严重程度提供参考。方法　本文为试验研究。选取2021年1月至2022年12月于河南省职工医院就诊的肺炎患者80例［男42例、女38例，年龄（52.65±7.32）岁］，根据急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分，其中危重型及以上（APACHEⅡ评分≥12分）36例，非危重型（APACHEⅡ评分<12分）44例；另选择健康体检者50例［男27例、女23例，年龄（55.21±5.53）岁］作为对照组。利用流式细胞仪、血栓弹力图测定机体细胞因子、凝血因子活性、纤维蛋白原水平、血小板计数、淋巴细胞指标。细胞因子、凝血功能、淋巴细胞与肺炎严重程度的相关性采用Spearman相关性分析。采用χ²检验、单因素方差分析、独立样本t检验。结果　危重组干扰素-γ（IFN-γ）［（26.28±4.63）ng/L］、白细胞介素（IL）-4［（41.43±4.33）ng/L］、IL-10［（30.35±7.96）ng/L］、IL-8［（121.12±30.53）ng/L］、IL-1β［（30.52±3.19）ng/L］、IL-6［（430.47±110.23）ng/L］、凝血因子活性R时间［（10.43±0.85）min］、纤维蛋白原水平K时间［（3.92±0.31）min］均高于非危重组［（13.61±2.44）ng/L、（15.55±3.76）ng/L、（12.44±2.57）ng/L、（27.25±6.91）ng/L、（14.42±2.95）ng/L、（90.55±22.67）ng/L、（7.26±0.64）min、（2.12±0.29）min］及对照组［（5.22±1.77）ng/L、（6.32±1.50）ng/L、（5.26±1.23）ng/L、（14.42±3.56）ng/L、（7.44±2.72）ng/L、（7.16±2.23）ng/L、（4.22±0.50）min、（1.28±0.41）min］，差异均有统计学意义（均P<0.05）。危重组纤维蛋白原水平α角［（42.62±3.37）deg］、血小板功能最大振幅（maximum amplitude，MA）［（39.61±2.87）mm］均低于非危重组［（55.38±4.44）deg、（51.23±3.76）mm］及对照组［（72.44±4.82）deg、（71.62±3.54）mm］，差异均有统计学意义（均P<0.05）。危重组淋巴细胞亚群CD3⁺［（48.42±3.38）%］、CD4⁺［（29.56±1.15）%］、CD4⁺/CD8⁺［（1.15±0.16）］均低于非危重组［（62.27±3.21）%、（37.22±2.72）%、（1.46±0.20）］及对照组［（78.15±4.22）%、（42.32±1.56）%、（1.85±0.13）］，差异均有统计学意义（均P<0.05）。结论　凝血功能、细胞因子、淋巴细胞亚群与肺炎严重程度具有明显相关性，可通过测定凝血功能、细胞因子、淋巴细胞亚群功能判断机体感染程度，为临床诊疗肺炎提供参考。

关键词:

凝血功能, 细胞因子, 淋巴细胞亚群, 肺炎

Abstract:

Objective　To investigate the correlations between coagulation function, cytokines, and lymphocyte subsets and severity in patients with pneumonia, so as to provide reference for clinical evaluation of the severity of pneumonia infection. Methods　It was an experimental study. A total of 80 patients with pneumonia [42 males and 38 females,aged (52.65±7.32) years] who were treated in Henan General Hospital from January 2020 to December 2022 were selected. According to the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ), they were divided into 36 critical and above cases (APACHEⅡ score ≥12 points) and 44 non-critical cases (APACHEⅡ score <12 points). In addition, 50 healthy controls [27 males and 23 females, aged(55.21±5.53) years] who underwent physical examination in our hospital were selected as the control group. The cytokines, coagulation factor activity, fibrinogen level, platelet count, and lymphocytes were measured by flow cytometry and thromboelastogram. The correlations between cytokines, coagulation function, and lymphocyte subsets and severity of pneumonia were analyzed by Spearman correlation analysis. χ² test, one-way analysis of variance, and independent sample t test were used. Results　The levels of interferon-γ (IFN-γ) [(26.28±4.63) ng/L], interleukin (IL) -4 [(41.43±4.33) ng/L], IL-10 [(30.35±7.96) ng/L], IL-8 [(121.12±30.53) ng/L], IL-1β [(30.52±3.19) ng/L], IL-6 [(430.47±110.23) ng/L], R time of coagulation factor activity [(10.43±0.85) min], and K time of fibrinogen [(3.92±0.31) min] in the critical group were higher than those in the non-critical group [(13.61±2.44) ng/L, (15.55±3.76) ng/L, (12.44±2.57) ng/L, (27.25±6.91) ng/L, (14.42±2.95) ng/L, (90.55±22.67) ng/L, (7.26±0.64) min, and (2.12±0.29) min] and the control group [(5.22±1.77) ng/L, (6.32±1.50) ng/L, (5.26±1.23) ng/L, (14.42±3.56) ng/L, (7.44±2.72) ng/L, (7.16±2.23) ng/L, (4.22±0.50) min, and (1.28±0.41) min], with statistically significant differences (all P<0.05). The α angle of fibrinogen [(42.62±3.37) deg] and maximum amplitude (MA) of platelet function [(39.61±2.87) mm] in the critical group were lower than those in the non-critical group [(55.38±4.44) deg and (51.23±3.76) mm] and the control group [(72.44±4.82) deg and (71.62±3.54) mm], with statistically significant differences (all P<0.05). The lymphocyte subsets CD3⁺ [(48.42±3.38)%], CD4⁺ [(29.56±1.15)%], and CD4⁺/CD8⁺ [(1.15±0.16)] in the critical group were lower than those in the non-critical group [(62.27±3.21)%, (37.22±2.72)%, and (1.46±0.20)] and the control group [(78.15±4.22)%, (42.32±1.56)%, and (1.85±0.13)], with statistically significant differences (all P<0.05). Conclusions　Coagulation function, cytokines, and lymphocyte subsets have obvious correlations with severity of pneumonia. The degree of infection can be determined by measuring coagulation function, cytokines, and lymphocyte subsets, providing reference for clinical diagnosis and treatment of pneumonia.

Key words:

Coagulation function, Cytokines, Lymphocyte subsets, Pneumonia

李明伟肖慧芳冯玉龙.

凝血功能及机体免疫功能与肺炎严重程度的相关性分析 [J]. 国际医药卫生导报, 2023, 29(15): 2105-2109.

Li Mingwei, Xiao Huifang, Feng Yulong.

Correlation analysis of coagulation function, body immunity, and severity of pneumonia [J]. International Medicine and Health Guidance News, 2023, 29(15): 2105-2109.

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