Analysis Of The Characteristics Of Cellular Immune Function And Its Prognostic Risk Factors In Patients With Community-acquired Pneumonia

Objective:Community-acquired pneumonia(CAP)refers to the infectious pulmonary parenchymal inflammation outside the hostital,which is the main cause of hospitalization and death of respiratory patients,especially elderly patients.T cell subsets play an important role in participating in cellular immune and inflammatory responses.This study,by retrospectively analyzing the clinical data of CAP inpatients,aimed to explore the characteristics of changes such as cellular immune function and prognostic risk factors in CAP patients,and to provide clinical basis for evaluating the development of CAP disease.Methods:In this study,a retrostective study was used to collect the clinical data of patients diagnosed as CAP admitted to department of respiratory and critical care medicine of The Second Affiliated Hospital of Anhui Medical University from June2018 to February 2019.106 patients were finally enrolled.The patients were divided into survival group and death group according to the mortality at discharge and28-day survival after hospital discharge;in addition,they were divided into bacterial group,fungi group and mixed infection group according to pathogen results at discharge.The differences of clinical data among groups were analyzed by Pearson test or Logistic regression.Results:1.Compared with the survival group,plasma albumin level,total T cell count,CD4~+T cell count,CD8~+T cell count were decreased in the death group,temperature,PH,acute physiology and chronic health evaluation?(APACHE?),procalcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP)were increased,and the length of hospital stay was significantly shortened.Whilethere was no significant difference regulation T cell/effect T cell(TREG/TEF)between the two groups.2. Pearson test showed that plasma albumin,the length of hospital stay,APACHE? correlated with death(r value was-0.480,-0.209,0.203,-0.279,-0.270,0.271,0.247,0.410,0.329,all P<0.05).Logistic regression analysis showed that plasma albumin,CD4~+T cell count,CD8~+T cell count,CD4~+/CD8~+decreased;APACHE?score,PCT,IL-6,and CRP increased;The length of hospital stay were correlated with death,and all were independent risk factors for death in CAP patients(all P<0.05).3. Pearson test showed that the APACHE?score was negatively related to plasma albumin(r value was -0.375,P<0.05),positively related to CRP and IL-6(r value was 0.363 and 0.333 respectively,both P<0.05);negative correlation between plasma albumin and IL-6(r value was-0.372,P<0.05),PCT and CD4~+T cell coun T(r value was-0.354,P<0.05),CRP and the length of hospital stay(r value was-0.356,P<0.05).There were no significant correlations between the others.4. There was no significant difference in cellular immune function or inflammatory factor expression between different pathogenic infections.Conclusions:Cellular immune dysfunction,hypoproteinemia,APACHE?score and elevated inflammatory index are all influential factors for the death of CAP patients.Apart from conventional anti-infective treatment,the symptoms of hypoproteinemia and cellular immune function can predict the severity and prognosis of CAP patients.