【摘要】 目的 观察存在免疫抑制的重症社区获得性肺炎（SCAP）患者血清巨噬细胞效应分子血清肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)的水平变化。方法 185例SCAP患者，其中免疫正常者131例（免疫正常组）、存在免疫抑制者54例（免疫抑制组）。分别于进入ICU第1、3、7天时抽取两组外周静脉血检测血清TNF-α及IL-6。第1天时抽取两组外周静脉血采用三色流式细胞术测算外周血总T细胞（CD3~+T）、CD3~+CD4~+T细胞（CD4~+T）、CD3~+CD8~+T细胞（CD8~+T）。两组均于ICU第1天时采用急性生理与慢性健康Ⅱ（APACHEⅡ）评分，分别于ICU第1、3、7天时采用序贯器官衰竭（SOFA）评分评估病情严重程度。Spearman秩相关分析法分析血清TNF-α、IL-6水平与存在免疫抑制的SCAP患者APACHEⅡ评分、SOFA评分相关性。ICU第7天时判定两组预后。结果 与免疫正常组比较，免疫抑制组ICU第1天血清TNF-α水平低、ICU第7天血清TNF-α水平高，ICU第3、7天血清IL-6水平高（P均<0.05）；与ICU第1天比较，免疫正常组及免疫抑制组第3、7天血清TNF-α、IL-6水平高（P均<0.05）；与ICU第3天比较，免疫抑制组ICU第7天血清TNF-α、IL-6水平高（P均<0.05）。与免疫正常组比较，第1天免疫抑制组CD4~+T、CD8~+T、CD3~+T计数较低，APACHEⅡ评分高（P均<0.05）；与ICU第1、3天比较，ICU第7天免疫抑制组患者SOFA评分高（F=19.722,P<0.05）；与免疫正常组比较，ICU第3、7天免疫抑制组患者SOFA评分高（t分别为4.162、7.317;P<0.05）。血清TNF-α及IL-6水平与存在免疫抑制的SCAP患者APACHEⅡ评分、SOFA评分均呈正相关（P均<0.05）。免疫抑制组患者好转率低于免疫正常组（χ~2=5.904;P<0.05）。结论 与免疫正常的SCAP患者相比，免疫抑制SCAP患者血清TNF-α、IL-6水平均升高，病情严重，预后差。检测存在免疫抑制的SCAP患者血清TNF-α、IL-6有助于评估患者病情严重程度，预测预后。更多还原

【Abstract】 Objective To investigate the expression changes of effectors of macrophage cells tumor necrosis factor（TNF）-α and interleukin-6（IL-6） in immunosuppressive patients with severe community-acquired pneumonia（SCAP）.Methods Totally 185 SCAP patients were divided into two groups:immunocompetent group（n=131） and immunosuppressive group（n=54）.Blood samples were collected after ICU admission on the first,third and seventh days.The samples were used for the measurements of serum TNF-α and IL-6 levels on 1^st,3^rd and 7^th days,and also for the measurements of the number of total T lymphocyte（CD3⁺T）,CD3⁺CD4⁺T lymphocyte（CD4⁺T） and CD3⁺CD8⁺T lymphocyte（CD8⁺T）.Acute Physiology and Chronic Health Evaluation（APACHE） Ⅱ score was recorded on 1^st day and Sequential Organ Failure Assessment（SOFA） score were recorded on 1^st,3^rd and 7^th days.The relationships between the levels of serum TNF-α and IL-6 and APACHE Ⅱ score and SOFA score were carried out by Spearman rank correlation analysis.The patients’ prognosis in the two groups on the 7^th day was determined.Results The immunosuppressive group had lower serum level of TNF-α on the 1^st day,higher serum level of TNF-α on the 7^th day and higher serum levels of IL-6 on the 1^stand 7^th days than the immunocompetent group（all P<0.01）.Both of serum levels of TNF-α and IL-6 on the 3^rd,7^th days were higher than those on the 1^st day in the two groups（all P<0.01）.Both of serum levels of TNF-α and IL-6 on the 7^th day were higher than those on the 3^rd day in immunosuppressive group（both P<0.01）.The immunosuppressive group had lower number of CD4⁺T,CD8⁺T,CD3⁺T,and higher APACHE Ⅱ score on the 1^st day than immunocompetent group（all P<0.01）.SOFA score on the 7^th day was higher than those on the 1^st and 3^rd days in immunosuppressive group（F=19.722,both P<0.05）.The immunosuppressive group had higher SOFA scores on the 3^rd and 7^th days than immunocompetent group（t=4.162,7.317;both P<0.05）.Correlation analysis showed that APACHE II score and SOFA score were positively correlated with serum levels of TNF-α and IL-6.The improvement rate in the immunosuppressive group was lower than that in the immunocompetent group（χ²=5.904,P<0.05）.Conclusions Compared with the immunocompetent SCAP patients,immunosuppressive SCAP patients have higher serum levels of TNF-α and IL-6.The condition are more serious and the prognosis is poorer in immunosuppressive SCAP patients.The results suggest that detection of serum levels of TNF-α and IL-6 is helpful to evaluate the severity and prognosis of the SCAP patients.更多还原