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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:

17

期数:

2020年03期

页码:

323-326

栏目:

论著

出版日期:

2020-06-15

文章信息/Info

Title:

Analysis and research on immune level and infection risk in patients with traumatic brain injury

文章编号:

202003017

作者:

冯芜若; 虞文魁; 尤勇; 曹科; 张北源

210008 南京，南京大学医学院附属南京鼓楼医院重症医学科

Author(s):

FENG Wu-ruo;  YU Wen-kui Yu;  YOU Yong;  et al.

Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing Medical University, Nanjing 210008, China

关键词:

颅脑外伤; 免疫功能; 感染; 预后

Keywords:

traumatic brain injury infection immune function prognosis

分类号:

R651.1+5

DOI:

DOI:10.3969/j.issn.1672-7770.2020.03.017

文献标志码:

A

摘要:

目的探讨不同程度颅脑外伤患者的免疫功能、感染风险及对预后的影响。方法南京大学医学院附属南京鼓楼医院重症医学科2016年9月—2019年9月收治的急性颅脑外伤患者86例；按格拉斯哥昏迷量表(Glasgow coma scale，GCS)评分标准分为轻中型组（24例）和重型组（62例）。收集两组患者入院时一般资料、炎症指标及免疫指标；并统计入院1~3 d、4~7 d、7~14 d内的新增感染患者例数及入院14 d内的死亡例数。以入院14 d内出现死亡为预后指标，分析影响颅脑外伤患者入院14 d内预后的相关因素。结果与重型组相比，轻中型组患者的血白细胞(WBC)计数、C反应蛋白(C-reactive protein,CRP)、血降钙素原(procalcitonin，PCT)水平均显著降低，血淋巴细胞(CD4+、CD8+)、人类白细胞抗原-DR(human leukocyte antigen-DR,HLA-DR)水平均显著升高。经多因素Logistics回归分析显示，WBC、PCT、入院后第1~3 d内发生感染是影响预后的独立危险因素，HLA-DR是影响预后的独立保护因素。结论重型颅脑外伤患者比轻中型患者的免疫功能更低下、感染出现时间更早、感染程度更重，且易合并多部位感染。早期血WBC、PCT水平、入院后第1~3 d内发生感染是影响患者生存的独立危险因素；而HLA-DR是影响生存的独立保护因素。入院时应评估患者的感染情况及免疫功能，并动态监测；尽早控制感染、提高免疫水平，以改善患者的预后。

Abstract:

Objective To explore the level of infection status and immune function changes and its effect on prognosis in patients with different severity of traumatic brain injury. Methods The data of 86 patients with traumatic brain injury in Nanjing Drum Tower Hospital from September 2016 to September 2019, which were divided into light and medium group(24 cases) and heavy group(62 cases) according to the Glasgow Coma Scale(GCS) score were analyzed retrospectively. The results of general conditions, inflammatory indicators and immune indicators of the two groups at admission were collected. The number of new infections within different time periods of admission, and the number of deaths within 14 days of admission were counted. The influencing factors of the prognosis of patients with craniocerebral trauma within 14 days after admission were analyzed retrospectively. Results Compared with the heavy group, the levels of white blood cell count(WBC), C-reactive protein(CRP), and procalcitonin(PCT) were significantly lower than that in the light and medium groups. Human leukocyte antigen-DR(HLA-DR), blood lymphocyte counts(CD4+, CD8+) were significantly higher. The results of multivariate Logistics regression analysis showed that WBC, PCT, and infection within 1-3 days after admission were independent risk factors affecting prognosis. HLA-DR was an independent protective factor affecting prognosis. Conclusions Compared with the light and medium group, the heavy group has lower immune function, earlier infection, more severe infection, and more likely to be infected with multiple sites. The 1evels of WBC, PCT, and infection within 1-3 days after admission are affecting survival. As an independent risk factor, HLA-DR is an independent protective factor that affects survival. Patients should be evaluated for infection and immune function when they are admitted to the hospital and dynamically monitored to control infection as soon as possible andtoenhance immune level to improve the prognosis of patients.

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更新日期/Last Update: 2020-06-17