慢性阻塞性肺部疾病急性加重细胞和体液免疫状态与评价

目的探讨慢性阻塞性肺部疾病急性加重（AECOPD）患者细胞、体液免疫状态及其与急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分的关系。方法前瞻性收集AECOPD患者临床资料与入科24小时和入科第7天外周血标本，流式细胞仪检测细胞免疫指标-T淋巴细胞亚群（CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋），免疫散射比浊法检测体液免疫指标（IgG、IgA、IgM）；依据APACHEⅡ评分分组，比较其与细胞、体液免疫指标相关性。结果75例AECOPD患者，男37例，女38例，平均年龄（76．4±9．8）岁，APACHEⅡ评分（22．77±5．27）分；APACHEⅡ评分≤21分组37例，男19例，女18例，平均年龄（75．08±10．42）岁，APACHEⅡ评分（18．43±1．86）分；〉21分组38例，男18例，女20例，平均年龄（78．21±8．66）岁，APACHEⅡ评分为（27．08±3．96）分；两组患者入科24小时与入科第7天细胞、体液免疫指标比较差异无统计学意义（P〉0．05），≤21分组入科24小时与入科第7天各项指标比较差异均无统计学意义（P〉0．05），〉21分组人科24小时CD4^＋／CD8^＋、IgG低于入科第7天（P〈0．05）；所有患者细胞、体液免疫指标与APACHEⅡ无显著相关性（P〉0．05）。结论AECOPD患者存在不同程度细胞、体液免疫功能低下，APACHEⅡ评分对评价免疫状态不敏感。

Observation and evaluation on cellular and humoral immunity for patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the state of cellular and humoral immunity for patients with acute exacerbation of chronic obstructive pulmonary disease （ AECOPD ） and evaluate the correlation with acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ）. Methods The clinical data of patients with AECOPD were collected prospectively and their peripheral blood samples were got to test the indexes of cellular and humoral immunity in 24 h and 7th day after they were administrated to EICU and MICU. Cluster of differentiation CD3^＋ , CD4^＋ , CDs and CD4^＋/CD8^＋ were indexes as cellular immunity tested by flow cytometry and immunoglobulin （Ig）G, IgA, IgM as humoral immunity by nephelometry. Patients were divided to two groups（ ≤21 and 〉 21 ） according to score of APACHE Ⅱ and correlation with indexes of cellular and humoral immunity were compared. Results There were 75 cases with male/female 37/38,76.4 ± 9.8 years old of age and 22.8 ±5.3 score of APACHE Ⅱ. 37 eases were in group of ≤21 score of APACHE Ⅱ and 38 cases in another group of 〉 21. There were no significant differences for all indexes of cellular and humoral immunity in 24 h and 7th day after administrated to EICU and MICU between two groups （P 〉 0.05）. The same was as in group of ≤21 scores of APACHE Ⅱ except for group of 〉 21. The indexes of CD4^＋/CD8^＋ and IgG in group of 〉 21 were lower in 24h than in 7th day（P 〈 0.05 ）and the others were no significant differences（ P 〉0.05 ）. There were no correlation between all indexes and APACHE Ⅱ （r = 0. 163 - 0. 702 ,P 〉 0.05 ）. Conclusion Patients with AECOPD would have different lower level of immune station and APACHE Ⅱ score would not be sensitiv e score as immune station.