T淋巴细胞、免疫球蛋白水平联合预测重症肺炎患者院内死亡的价值

Value of T lymphocyte and immunoglobulin levels in predicting hospital death in patients with severe pneumonia

摘要:

目的 分析T淋巴细胞、免疫球蛋白水平联合预测重症肺炎患者院内死亡的价值。方法 回顾性分析2021年5月—2022年5月在成都中医药大学附属医院接受治疗的80例重症肺炎患者的临床资料，依据患者入院后1个月的存活情况分为死亡组（26例）和存活组（54例）。比较两组基线资料，以及T淋巴细胞［白细胞分化抗原3（CD3⁺）、白细胞分化抗原4（CD4⁺）、白细胞分化抗原8（CD8⁺）］、免疫球蛋白［免疫球蛋白A（IgA）、免疫球蛋白M（IgM）、免疫球蛋白G（IgG）］水平。绘制受试者工作特征（ROC）曲线分析入院时急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分，以及T淋巴细胞、免疫球蛋白水平联合预测重症肺炎患者院内死亡的价值。采用多因素逐步Logistic回归分析重症肺炎患者院内死亡的危险因素。结果 两组年龄、性别、体质量指数、合并症及呼吸频率比较，差异均无统计学意义（P >0.05）。死亡组APACHEⅡ评分高于存活组（P <0.05），CD3⁺、CD4⁺、CD8⁺、IgA、IgM及IgG水平低于存活组（P <0.05）。ROC曲线分析结果显示，T淋巴细胞、免疫球蛋白水平联合检测重症肺炎患者院内死亡的敏感性为90.3%（95% CI：0.757，0.954），特异性为78.8%（95% CI：0.654，0.819），曲线下面积（AUC）为0.854（95% CI：0.678，0.912）。入院时APACHEⅡ评分检测重症肺炎患者院内死亡的敏感性为71.1%（95% CI：0.657，0.873），特异性为96.2%（95% CI：0.751，0.984），AUC为0.801（95% CI：0.707，0.894）。多因素逐步Logistic回归分析结果显示，入院时APACHEⅡ评分高［O^R=1.536（95% CI：1.118，2.110）］、CD3⁺［O^R=1.797（95% CI：1.122，2.878）］、CD4⁺［O^R=1.751（95% CI：1.121，2.735）］、CD8⁺［O^R=1.886（95% CI：1.075，3.309）］、IgA［O^R=1.967（95% CI：1.142，3.388）］、IgM［O^R=1.945（95% CI：1.145，3.304）］及IgG［O^R=2.132（95% CI：1.176，3.865）］均为重症肺炎患者院内死亡的影响因素（P <0.05）。结论 入院时APACHEⅡ评分、T淋巴细胞及免疫球蛋白水平预测重症肺炎患者院内死亡的价值较高，且T淋巴细胞、免疫球蛋白水平联合预测时具有更高的敏感性，可有效提高检测效率，另入院时APACHEⅡ评分高、CD3⁺、CD4⁺、CD8⁺、IgA、IgM及IgG均为重症肺炎患者院内死亡的影响因素，临床应结合以上指标对重症肺炎患者进行重点筛查，及时采取干预措施，降低病死率。

Abstract:

Objective To analyze the value of T lymphocytes, immunoglobulin levels in predicting in-hospital mortality of severe pneumonia patients.Methods A retrospective analysis of clinical data from 80 severe pneumonia patients treated at Chengdu University of Traditional Chinese Medicine Affiliated Hospital from May 2021 to May 2022 was conducted. Patients were divided into deceased group (26 cases) and survival group (54 cases) based on their survival status at one month after admission. Baseline data, T lymphocytes [CD3⁺, CD4⁺, CD8⁺], and immunoglobulins [IgA, IgM, IgG] were compared between the two groups. Receiver operating characteristic (ROC) curves were drawn to analyze the value of the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, as well as the combined prediction of T lymphocytes and immunoglobulin levels for in-hospital mortality of severe pneumonia patients. Multivariate stepwise logistic regression analysis was used to analyze the risk factors for in-hospital mortality of severe pneumonia patients.Results There were no significant differences in age, gender, body mass index, comorbidities, and respiratory rate between the two groups (P > 0.05). The APACHE Ⅱ score of the deceased group was higher than that of the survival group (P < 0.05), while the levels of CD3⁺, CD4⁺, CD8⁺, IgA, IgM, and IgG were lower than those of the survival group (P < 0.05). The ROC curve analysis showed that the sensitivity of combined detection of T lymphocytes and immunoglobulin levels in predicting in-hospital mortality of severe pneumonia patients was 90.3% (95% CI: 0.757, 0.954), the specificity was 78.8% (95% CI: 0.654, 0.819), and the area under the curve (AUC) was 0.854 (95% CI: 0.678, 0.912). The sensitivity of the APACHE Ⅱ score at admission in predicting in-hospital mortality of severe pneumonia patients was 71.1% (95% CI: 0.657, 0.873), the specificity was 96.2% (95% CI: 0.751, 0.984), and the AUC was 0.801 (95% CI: 0.707, 0.894). The results of multivariate stepwise logistic regression analysis showed that high APACHE Ⅱ score at admission [O^R = 1.536 (95% CI: 1.118, 2.110)], CD3⁺ [O^R = 1.797 (95% CI: 1.122, 2.878)], CD4⁺ [O^R = 1.751 (95% CI: 1.121, 2.735)], CD8⁺ [O^R = 1.886 (95% CI: 1.075, 3.309)], IgA [O^R = 1.967 (95% CI: 1.142, 3.388)], IgM [O^R = 1.945 (95% CI: 1.145, 3.304)], and IgG [O^R = 2.132 (95% CI: 1.176, 3.865)] were all influencing factors for in-hospital mortality of severe pneumonia patients (P < 0.05).Conclusion The value of APACHE Ⅱ score, T lymphocyte, and immunoglobulin levels at admission in predicting in-hospital mortality of severe pneumonia patients is high, and the sensitivity is higher when T lymphocytes and immunoglobulin levels are combined for prediction, which can effectively improve the detection efficiency. Additionally, high APACHE Ⅱ score, CD3⁺, CD4⁺, CD8⁺, IgA, IgM, and IgG are all influencing factors for in-hospital mortality of severe pneumonia patients. Clinicians should focus on screening severe pneumonia patients based on the above indicators and take timely intervention measures to reduce mortality.