目的:探究多发伤所致急性呼吸窘迫综合征(ARDS)早期免疫细胞动态变化与肺部感染的相关性.方法:选择2017年10月至2023年2月湖南中医药大学第一附属医院收治的多发伤并发ARDS患者(235例)为研究对象,纳入训练集;根据简易临床肺部感染评分(sCPIS)分为肺部感染组(94例,>6分)和未感染组(141例,≤6分).另选多发伤并发ARDS患者(78例)纳入验证集,以验证预测模型的有效性.采用流式细胞仪进行淋巴细胞的动态检测.对比分析两组患者的临床资料.构建联合模型,利用Cox回归分析关系.多因素Logistic回归分析危险因素,构建简易风险评分模型并评价.结果:随患者病程进展,CD4+、CD8+先下降后上升,发病3～15 d是最低阶段;CD19+逐渐上升;CD16+逐渐下降,并在一定范围内波动.联合模型显示,CD4+、CD8+、CD19+和CD16+每纵向下降1个/µl,肺部感染的风险分别增加5.6%、4.1%、3.4%和1.3%(P<0.05).损伤严重度评分(ISS)、以胸部损伤为主、急诊手术、急性生理功能与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)、支气管肺泡灌洗液(BALF)sTREM-1水平以及发病15 d CD4+、CD8+、CD19+水平,均为肺部感染发生的独立影响因素(P<0.05).简易风险评分模型的评分在0～36.7分,可划分为低(<16分)、中(16～22分)和高危(>22分)3个风险等级;训练集与验证集患者的肺部感染发生率差异无统计学意义(P>0.05).评价结果显示,该预测模型的区分度良好.结论:免疫细胞波动将增加多发伤ARDS患者肺部感染风险;基线CD4+、CD8+以及CD19+水平,均为肺部感染发生的独立影响因素;控制高水平免疫细胞并维持平稳对预后改善十分重要.
Study on correlation between early immune cell dynamic changes and lung infection in acute respiratory distress syndrome caused by multiple injuries
Objective:To explore the correlation between the dynamic changes of early immune cells in acute respiratory dis-tress syndrome(ARDS)caused by multiple injuries and lung infection.Methods:Multiple injury patients with ARDS(235 cases)ad-mitted to the First Affiliated Hospital of Hunan University of Chinese Medicine from October 2017 to February 2023 were selected as the research subjects and included them in the training set;according to simple clinical pulmonary infection scores(sCPIS),they were divided into a pulmonary infection group(94 cases,>6 points)and an uninfected group(141 cases,≤6 points).Another multi-ple injury patients with ARDS(78 cases)were selected to be included in the validation set to verify the effectiveness of the prediction model.Dynamic detection of lymphocytes were used flow cytometry.Compared and analyzed the clinical data of two groups of patients.Constructed a joint model and used Cox regression to analyze the relationship.Multi factor Logistic regression analysis of risk factors,construction of a simple risk scoring model and evaluation.Results:As the patient progresses,CD4+and CD8+first decrease and then increased,and the lowest stage was 3～15 d after onset;CD19+was gradually increasing;CD16+gradually decreased and fluctuated within a certain range.The joint model showed that for every 1 piece/µl longitudinal decrease in CD4+,CD8+,CD19+,and CD16+,the risk of pulmonary infection increased by 5.6%,4.1%,3.4% and 1.3%,respectively(P<0.05).Injury severity score(ISS),chest inju-ry as the main factor,emergency surgery,acutephysiology and chronic health evaluation Ⅱ(APACHE Ⅱ),broncho-alveolar lavage fluid(BALF)sTREM-1 level,and CD4+,CD8+,and CD19+level on the 15th day after onset all were independent influencing factors for the occurrence of pulmonary infection(P<0.05).The score of the simple risk scoring model is 0～36.7 points,which could be divid-ed into three risk levels:low(<16 points),medium(16～22 points),and high risk(>22 points);there was no significant difference in the incidence of pulmonary infection between the two episodes of patients(P>0.05).The evaluation results showed that the predic-tive model has good discrimination.Conclusion:The fluctuation of immune cells will increase the risk of pulmonary infection in pa-tients with multiple injuries ARDS;Baseline CD4+,CD8+,and CD19+levels are independent influencing factors for the occurrence of pulmonary infection;controlling high-level immune cells and maintaining stability is crucial for improving prognosis.
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