Correlation Between Peripheral Blood T Lymphocyte Subsets And Pulmonary Fungal Infection In Patients With Chronic Obstructive Pulmonary Disease

Objectives By detecting the level of peripheral blood T lymphocyte subsets(CD3~+ CD4~+ percentage,CD3~+CD8~+ percentage and CD3~+CD4~+/CD3~+CD8~+ ratio),combined with 1,3-?-D glucan(BG)levels,the level of T cell subsets and chronic Correlation of patients with obstructive pulmonary disease and pulmonary fungal infection.Methods Patients with chronic obstructive pulmonary disease and pulmonary fungal infection(88 cases)admitted to the Department of Respiratory and Critical Care Medicine,North China University of Technology Hospital from June 2018 to December 2019 were selected as the case group(fungal group).Patients(97 cases)served as a control group.Register general information of all study subjects: gender,age,height,weight,smoking history,number of hospitalizations,years of confirmed COPD,combined underlying disease(diabetes,pulmonary heart disease),combined respiratory failure,use of broadspectrum antibiotics(Type of use,time of use),etc;simultaneous laboratory tests such as serum albumin,BG,T lymphocyte subpopulation levels,etc,and the patient's deep sputum or(and)bronchoalveolar lavage fluid(BALF)(respiratory tract)Secretions sent to the fungal smear and culture,record all data.SPSS 22.0 statistical software was used for data analysis for statistical analysis.P<0.05 was considered statistically significant.Results 1 Among 88 patients in the fungal group,the main infection was Aspergillus fumigatus(48.86%),followed by Candida albicans(18.18%)and Aspergillus flavus(14.77%).2 There was no statistically significant difference between the fungus group and the control group in terms of gender,age,BMI,years of diagnosed COPD,smoking index,respiratory failure,history of pulmonary heart disease,and use of antibiotics?2(P>0.05);There was a statistically significant difference between the two groups in the history of diabetes,serum albumin level,antibiotic use time?7d,and the number of hospitalizations?3 times/year(P<0.05).3 The rate of dyspnea in the fungal group was higher than that of the control group,the difference was statistically significant(P<0.05);fever,cough,sputum,hemoptysis,chest pain,dry rales,lung There was no statistically significant difference in the proportion of moist rales in the part(P>0.05).4 Chest CT imaging showed the proportion of infiltrating consolidation,hollowing,nodules,and halo signs.There was no statistically significant difference between the two groups(P>0.05);chest CT imaging of the fungal group showed: The ratio of pleural effusion and crescent sign was higher than that of the control group,and the difference was statistically significant(P<0.05).5 The BG level in the fungus group was higher than that in the control group,and the difference was statistically significant(P<0.05);the difference in WBC,PCT,and CRP levels between the two groups was not statistically significant(P>0.05).6 The level of CD3~+CD8~+% in the fungal group was higher than that in the control group,and the levels of CD3~+CD4~+% and CD3~+CD4~+/CD3~+CD8~+ were lower than that in the control group,the difference was statistically significant(P<0.05);no comparable factors were controlled Later,CD3~+CD4~+%,CD3~+CD8~+% and CD3~+CD4~+/CD3~+CD8~+ levels were associated with pulmonary fungal infection in patients with COPD(P<0.05).Increased levels of CD3~+CD8~+%,decreased levels of CD3~+CD4~+% and decreased levels of CD3~+CD4~+/CD3~+CD8~+ can increase the risk of COPD with pulmonary fungal infections,especially CD3~+CD8~+% levels are more closely related.7 BG,CD3~+CD8~+% and the area under the ROC curve of the combined trial are all greater than 90%(P<0.05),and have a high predictive power.The predicted boundary value is 23.22 for BG and 28.55 for CD3~+CD8~+%.BG>23.22,CD3~+CD8~+%>28.55 can be judged to be combined with fungal infection;8 BG,CD3~+CD8~+% level and the combined test of the two(parallel)are all in the evaluation of the risk of pulmonary fungal infection in patients with COPD High consistency(Kappa>0.78),the joint test of two indicators can greatly improve the sensitivity of clinical prediction and reduce the rate of missed diagnosis.Conclusions 1 The pathogenic strains of patients with COPD and pulmonary fungal infection are mainly Aspergillus and yeast.2 The level of T lymphocyte subsets is associated with COPD combined with pulmonary fungal infections.CD3~+CD8~+ percentage increases,CD3~+CD4~+ percentage and CD3~+CD4~+/CD3~+CD8~+ ratio levels decrease,which may increase COPD patients with lungs.The risk of fungal infections.3 BG,CD3~+CD8~+ percentage and the combined test(parallel)are highly consistent in assessing the risk of pulmonary fungal infection in patients with COPD.The combined test of the two indicators can greatly improve the sensitivity of clinical prediction to reduce the rate of missed diagnosis.Figure1;Table11;Reference 181...