Effect Of CD4~+T Cells On Inflammatory Response And Clinical Outcome Of Invasive Pulmonary Fungal Infection

Objective:To investigate the effect of CD4+T lymphocytes on the inflammatory response and clinical outcome of severe invasive pulmonary fungal infection(PIFI)for early diagnosis and early treatment.Methods:Patients with PIFI admitted to the respiratory intensive care unit(RICU)of the First Affiliated Hospital of Xinjiang Medical University in the past four years were retrospectively analyzed,and patients were divided into two groups based on their first CD4~+T lymphocyte count after admission to the RICU,<300/mm~3and≥300/mm~3.(1)Univariate analysis was performed on the inflammatory response indexes of the two groups,and the statistically significant indexes in the results of univariate analysis were included in the logistic regression analysis,and ROC curves were drawn to assess the characteristics of changes in the inflammatory response indexes of patients in different CD4~+T lymphocyte groups.(2)To compare the variability of clinical outcome indicators between the two groups.Results:A total of 211 patients were included in the study,of which 117(55.5%)were in the CD4~+T lymphocyte<300/mm~3group and 94(44.5%)were in the CD4~+T lymphocyte≥300/mm~3group.(1)The results of univariate analysis of inflammatory response indexes in both groups showed that Procalcitonin(PCT)[10~9/L:0.40(0.14,1.65)vs 0.21(0.08,0.56)],C-reactive protein(CRP)[mg/L:45.60(14.35,90.00)vs 24.10(9.97,53.70)],interleukin-6(IL-6)[Pg/m L:59.64(26.12,255.90)vs 42.00(14.03,74.09)]and blood creatinine(Scr)[μmol/L:72.00(54.40,102.56)vs 60.10(47.01,84.26)]and D-dimer(D-D)[ng/m L:1182.00(638.50,3398.00)vs 895.00(478.00,2128.75)]were significantly higher(all P<0.05).Multifactorial logistic regression analysis showed that IL-6 was significantly higher in the CD4~+T lymphocyte count<300 cells/mm~3group(OR=0.997,95%CI=0.975-0.999,P<0.05).the area under the ROC curve was 0.628,with a sensitivity of 35.9%and specificity of 86.2%,suggesting that a CD4~+T lymphocyte count grouping had little predictive value for IL-6 augmentation;(2)The results of the comparison of outcome indicators between the two groups showed that compared with the CD4~+T lymphocyte≥300 cells/mm~3group,the rates of nosocomial infection[62.7%(79/117)vs 37.3%(47/94)],tracheal intubation[(57.4%(96/117)vs 42.6%(62/94))]and mortality[72.5%(58/117)vs 27.5%(22/94)]were significantly higher(all P<0.05),and the 30-d cumulative survival rate was significantly lower(P<0.05)..Conclusions:Patients with severe PIFI with CD4~+T lymphocyte counts<300 cells/mm~3did not necessarily have elevated indicators of inflammatory response,but had significantly higher rates of nosocomial infection,tracheal intubation and morbidity and mortality,and significantly lower 30-d cumulative survival rates.It is suggested that the effect of CD4~+T lymphocyte grouping on the level of early inflammatory indicators in patients with severe PIFI may not have a significant pattern of change,but with the decrease of CD4~+T lymphocytes,the survival rate of patients significantly decreased.