Study Of Clinical Immunology And Medical Costs In Children With Acute Severe Pneumonia

Objective: To analyze the changes of T-lymphocyte subsets, serum immunoglobulin, C₃, C₄, the situation of antibiotic application, the cure rate, the hospitalization time, and the hospitalization costs in children with acute severe pneumonia, we investigated the role of cellular immunity and humoral immunity in the development process of severe pneumonia, and this could provide new ideas of clinical diagnosis, treatment for acute severe pneumonia. At the same time, we investigated the extent of the antibiotic use, clinical outcomes, length of stay, hospital costs, and this could provide a basis to reduce the medical costs during the diagnosis and treatment of acute severe pneumonia.Methods: Using the method of retrospective studies,89cases in respiratorymedical ward of the Children’s Hospital in Dalian City admitted from January2010toDecember2011,age1–12years old, clinical diagnosis of pneumonia were selected,except for recurrent respiratory tract infection, congenital immune function, applicationof hormone or immunosuppressive agents, the congenital heart disease, congenital lungdysplasia, congenital respiratory tract malformations, and acute or chronic diseaseswhich were prone to cause immune dyfunction. They were divided into two groups.46patients who met the diagnostic criteria of severe pneumonia were selected as theobservation group, while43cases who met the diagnostic criteria for mild pneumoniawere selected as the control group. The levels of T lymphocyte subsets, including CD₃⁺,CD₄⁺and CD₈⁺expressed on the surfaces of peripheral blood lymphocytes, weredetected by the monoclonal antibody sensitized red blood rosette test, and the serumlevels of IgG, IgA, IgM and C₃, C₄were detected by the dual optical pathimmunoturbidimetric assay. The levels of them between the two groups were compared.And its antibiotic use situation, the cure rates, the length of stay, the total hospital costs, the average daily costs and the western medicine costs were analyzed and compared.Results:1. The levels of CD₃⁺, CD₄⁺T cells and the ratio of CD₄⁺/CD₈⁺in the observationgroup were lower than that in the control group, and the differences were statisticallysignificant （P<0.05）; The levels of IgM in the observation group were higher than thatin the control group, the difference was statistically significant （P<0.05）.The differencesof the CD₈⁺, IgG, IgA and C₃, C₄levels were no statistically significant （P>0.05）.2. The utilization rates of the third generation cephalosporins in the observationand control group were54.3%and30.2%, respectively. The fourth generationcephalosporins were47.8%and4.7%, respectively. The carbapenems were60.9%and0%, respectively. And the vancomycin were23.9%and0%， respectively. Theutilization rates of the third generation cephalosporins, the fourth generationcephalosporins, carbapenems and vancomycin in the observation group increasedsignificantly than that in the control group, and the differences were statisticallysignificant （P<0.05）.3. The cure rate was60.87%in the observation group, and100%in the controlgroup. The cure rate was significantly lower in the observation group than that in thecontrol group, and the difference was statistically significant （P<0.05）.The longesthospitalization days were33days in observation group, and18days in the controlgroup. The median of the hospitalization days was8days longer in the observationgroup than that in the control group, and the former is1.89times of the latter. Thehospitalization time of the observation group was significantly prolonged than that ofthe control group, and the difference was statistically significant（P<0.05）.4. The median of the total hospital costs in the observation group increased14826.95Yuan than that in the control group, the former is3.49times of the latter. Thetotal hospital costs of the observation group was significantly higher than that of thecontrol group, and the difference was statistically significant （P<0.05）. The median ofthe average daily costs in the observation group than that of the control group increased510.87Yuan, the former is1.87times of the latter. The average daily costs of theobservation group were significantly higher than that of the control group, and thedifference was statistically significant （P<0.05）. The median of western medicine costsin the observer group increased6407.01Yuan compared with that of the control group,the former is3.24times of the latter, and the difference was statistically significant（P<0.05）. Conclusion:1. The levels of CD₃⁺, CD₄⁺T cells and the ratio of CD₄⁺/CD₈⁺in the childrenwith acute severe pneumonia were significantly lower, and the levels of IgM in thechildren with acute severe pneumonia were significantly increased. Cellular andhumoral immune dysfunction existed in the children with acute severe pneumonia.2. The utilization rates of the third generation cephalosporins, the fourthgeneration cephalosporins, carbapenems and vancomycin in the children with acutesevere pneumonia increased significantly.3. The cure rate in the children with acute severe pneumonia decreasedsignificantly. And the length of hospital stay extended significantly in the children withacute severe pneumonia.4. The medical costs increased significantly in the children with acute severepneumonia.The total hospital costs, the average daily costs of hospitalization increasedsignificantly; and the western medicine costs increased significantly in the children withsevere pneumonia.