CD4+T淋巴细胞计数在慢性肾衰竭患者衰弱状态评价中的监测意义

目的 探索CD4+T淋巴细胞计数在慢性肾功能衰竭衰弱状态患者营养监测及预后判断中的意义.方法 通过青岛大学附属医院医渡云数据库筛选出2013年至2020年符合条件的慢性肾功能衰竭患者381例.于入院时检测CD4+T淋巴细胞计数及与免疫、营养相关指标,并进行急性生理和慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭估计(S...

Monitoring significance of CD4+ T lymphocyte count on evaluating frailty status of chronic renal failure in patients

Objective To evaluate the significance of CD4⁺ T lymphocyte count in the evaluation of nutrition and prognosis of chronic renal failure in patients. Methods Totally 381 chronic renal failure patients were selected from YIDUCLOUD database of the Affiliated Hospital of Qingdao University during 2013 to 2020 for systematic analysis. CD4⁺ T lymphocyte counts and indicators related to immunity and nutrition of those patients were detected on admission, and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) score, and frailty score combined with Edmonton Frailty Scale were performed. As CD4⁺ T lymphocytes count of admission, patients were divided into three groups: A group of 67 cases (CD4⁺ T lymphocyte count< 200 cells/μl), B group of 175 cases (200 cells/μl≤CD4⁺ T lymphocyte count <544 cells/μl), and C group of 139 cases (CD4 ⁺ T lymphocyte count≥544 cells/μl). The correlation between CD4⁺ T lymphocyte counts, immune, nutrition-related indicators, SOFA score, APACHE Ⅱ score, and frailty score were analyzed. Kaplan-Meier survival curve was drawn. Results In this study, the overall proportion of frail patients was 36.5%(139/381), the proportion of frail patients was as high as 53.7%(130/242) at the count of CD4 ⁺ T lymphocytes <544 cells/μl, and the frail patients accounted for only 6.5% (9/139) at the count in the normal range. There was no significant difference in general data of admission among groups (all P>0.05), but the differences in serum total protein, prealbumin, albumin, APACHE Ⅱ score, SOFA score, and frailty score were statistically significant (all P<0.01). The difference in survival rate among the three groups was statistically significant (P<0.01). Conclusion Due to interactions of nutritional and immune status in chronic renal failure patients, the frail status cannot be ignored. The immune status of the patient can be improved by monitoring CD4 ⁺ T lymphocyte count and timely improving nutritional status, thereby improving the prognosis.