The Clinical Analysis Of Senile SAP Patients' T Lymphocyte Subsets In Peripheral Blood And Serum Inflammatory Factor

BackgroundMorbidity,disability rate and lethality of senile stroke patients are higher and it is the main cause of death for Chinese people.Stroke-Associated-Pneumonia(SAP)is the most frequently-used infectious type in post-stroke and also is the primary cause for dying for stroke at acute stage.The clinical occurrence rate is 15-65% and it is related to poor prognosis obviously.Central nervous system and immune system are closely related and interact.There is central fever or other factors in post-stroke,so as to impact judgment on infection and limit the diagnosis of bacterial infection.By observing some infectious indicators with higher specificity,including senior SAP patients' serum PCT and hs-CRP and combining with changes of T lymphocyte subsets in peripheral blood,the paper analyzed their immune state and clinical application value.ObjectivesThe study mainly discussed changes of senior SAP patients' changes of serum procalcitonin(PCT),hs-CRP and T lymphocyte subsets in peripheral blood and analyzed their clinical application value.MethodsThe study was an observational research.Senile SAP patients who accepted treatment in neurology of our hospital from March 2014 to September 2015 were selected as the research objects.Inclusion criteria:(1)patients who were hospitalized within 24 hours after attacking stroke;(2)patients who conformed to stroke diagnosis and complied with diagnostic criteria revision of the 4th national academic conference for cerebrovascular diseases;(3)Patients whose Diffusion Weighted Imaging of Magnetic Resonance showed as acute cerebral infarction or CT scanning proved it as newly cerebral hemorrhage(excluding primary subarachnoid hemorrhage);(4)Patients whose National Institutes of Health Stroke Scale(NIHSS)was more than 3 scores within 24 hours after being hospitalized and it was necessary to complete APACHEII scoring in line with clinical inspection results;(5)Patients whose age? 60 years old and whose diagnosis of pulmonary infection conformed to the diagnostic criteria of Chinese expert consensus on SAP diagnosis in 2010.On the 7th or 14 th day of being hospitalized,patients who completed satisfied the above-mentioned three indicators completely were divided into the infectious group(SAP group).On the other hand,patients whose above-mentioned three indicators weren't presented in the entire observation period were divided into the non-infectious group(non-SAP group).Exclusion criteria:(1)Patients who had history of apoplexy and craniocerebral trauma,as well as left over obvious neurologic impairment within 6 months before the onset;(2)Patients who had underlying chronic bacterial infectious diseases(such as bronchiectasia,abscess,skin infection and urinary tract infection,and so on)within 3 months before the onset;(3)Patients who had combined malignant tumor,serious hematological system diseases,autoimmune diseases and other central nervous system diseases;(4)Patients who had chronic alcoholism,drug-taking history or serious cardiac,pulmonary,hepatic and renal insufficiency;(5)Patients who had transient ischemic attack;(6)Patients who discharged or died within 24 hours.General data of patients were collected,including age,gender,personal history and previous history,NIHSS,to evaluate the degree of neurologic impairment.Infectious and immune indicators were collected: After being hospitalized,3ml peripheral venous blood of patients with an empty belly was taken in the morning of the next day and was placed into different test tubes for detecting PCT,hs-CRP and cell immune indicators(CD3~+,CD4~+,CD8~+ and CD4~+/CD8~+),respectively.Detection of inflammatory factor: the E170 full-automatic electrochemilumi-nescence immune analyzer and original kit produced by German BRAHM.S Company was applied to detect serum PCT.The upper limit of normal value was <0.5?g/L.The i-CHROMA full automatic protein analyzer was utilized to detect hs-CRP,and kit were provided by Korean Medical Diagnostic Product Company with the normal value <5mg/L.Detection of cell immune indicators: The EPICS-XL flow Cytometry scale produced by American Beckman Coulter was adopted to detect T lymphocyte subsets in peripheral blood.Moreover,Cell Quest software system was used to do quantitative analysis and record data.All data adopted SPSS23.0 software processing data.Measurement data were expressed by using mean±standard deviation(x ±s).Comparison among multiple groups of measurement data applied the F test.Comparison between two groups adopted the t test,and enumeration data utilized the ?2 test.If P<0.05,the difference had statistical significance.Results1 General data results of patients63 senile stroke patients who were hospitalized within 24 hours after the onset were collected continuously.When being hospitalized,patients were scored with NIHSS.According to the occurrence situation of SAP within 1 week,patients were divided into the SAP group and the non-SAP group.Meanwhile,30 normal old people in outpatient physical examination center in the same period were selected as the control group.Moreover,their basic clinical data situation,situation of infectious occurrence and scale scoring situation were compared.2 Comparative results of patients' serum PCT and hs-CRP in stroke groups and control groupSerum PCT and hs-CRP in both the SAP group and the non-SAP group were obvious higher than the control group;hs-CRP and PCT in the SAP group were significantly higher than the non-SAP group,respectively(P<0.05).Moreover,PCT in the SAP group was also significantly higher than the control group(P<0.05).3 Comparative results of patients' T lymphocyte subsets in stroke groups and control groupThe comparison of CD3~+,CD4~+,CD8~+ and CD4~+/CD8~+ in the SAP group,the non-SAP group and the normal group had significant difference and all of them had statistical significance(P<0.01).CD3~+ and CD4~+ T lymphocytes in the SAP group and non-SAP group were obviously lower than the control group,and the difference had statistical significance(P<0.01).CD8~+T lymphocytes in the SAP group and non-SAP group was higher than the control group,and the difference had statistical significance(P<0.01).CD4~+/CD8~+ in the SAP group and non-SAP group was lower than the control group,and the difference had statistical significance(P<0.01).Thus,it can be observed that the number and proportion of T lymphocytes of senile stroke patients were abnormal,but when patients had SAP,it might be likely to result in immunodeficiency of patients.Conclusions1 There was no obvious correlation between basic clinical data of patients with acute cerebrovascular diseases in the SAP group and the non-SAP group.The comparison of basic clinical data in both groups had no statistical difference within 24 hours of acute stroke(P>0.05),showing that inflammatory level at early stage of acute stroke was irrelevant to age,gender and basic diseases.After patients were hospitalized,the difference of APACHE II and NIHSS between the SAP group and the non-SAP group had statistical significance(P<0.01).The relationship between clinical rating scale and post-stroke immune function restraint is crucial to clinical diagnosis of SAP.2 Serum PCT in acute cerebrovascular patients was obviously higher than the control group and the difference had statistical significance.Serum PCT in the SAP group was significantly higher than the non-SAP group(P<0.05).It can be observed that serum PCT can impact stroke.PCT can be applied to distinguish from bacterial infection at early stage of stroke and guide antibiotic use.PCT plays the clinical significance on diagnosing SAP and can provide guidance for clinical diagnosis.3 hs-CRP in stroke patients was higher than patients in the control group.hs-CRP in the SAP group was significantly higher than the non-SAP group.Compared with the control group,hs-CRP in the non-SAP group had little increase.Therefore,it must be an inflammatory indicator with higher sensitivity and lower specificity.When hs-CRP was increased obviously,possibility of relevant stroke infection is larger and its guides therapeutic schedules and judgment prognosis for clinical physicians.4 CD3~+,CD4~+ and CD4~+/CD8~+ T lymphocytes of patients in stroke groups were averagely lower than the control group,while CD8~+ T lymphocytes was obviously higher than the control group,indicating that there is the abnormal number of immune cells and restraint of immune functions for patients in stroke groups.SAP is the principle that results in weakening immune system functions in post-stroke body.When necessary,it is necessary to provide drugs for regulating immune to promote patients' recovery.This has an important value on SAP patients.