目的 探讨血清心型脂肪酸结合蛋白（H-FABP）、血管生成素-1（Ang-1）在急性大血管闭塞性卒中（AIS-LVO）静脉溶栓桥接支架取栓患者预后中的评估价值。方法 选择2019年1月—2021年5月80例AIS-LVO患者作为研究对象,均接受静脉溶栓桥接支架取栓治疗,检测术前血清H-FABP、Ang-1水平,术后随访90 d将患者分为预后良好组（n=57）与预后不良组（n=23）。结果 两组在高血压、冠心病、心房颤动、急性卒中治疗低分子肝素试验（TOAST）分型、侧支循环、术前H-FABP、术前Ang-1方面存在差异（P<0.05）。多因素 Logistic 回归分析结果显示,高血压、心房颤动、心源性梗死型、侧支循环为0 ~1 级、术前H-FABP≥10.0 ng/L、术前Ang-1<5.25 ng/mL是AIS-LVO静脉溶栓桥接支架取栓患者预后不良的危险因素。术前血清H-FABP预测术后90 d预后不良的AUC为0.728（95%CI：0.368~0.918）,灵敏度、特异度分别为66.68%、58.92%。术前血清Ang-1预测术后90 d预后不良的AUC为0.773（95%CI：0.592~1.129）,灵敏度、特异度分别为70.35%、63.92%。H-FABP联合Ang-1预测术后90 d预后不良的AUC为0.854（95%CI：0.652~0.957）,灵敏度、特异度分别为77.18%、71.82%。结论 静脉溶栓桥接支架取栓治疗AIS-LVO患者的预后受到多种危险因素的影响,其中术前血清H-FABP和Ang-1是具有前景的预后预测因子。

Objective To investigate the prognostic value of serum heart-type fatty acid binding protein（H-FABP）and angiopoietin-1（Ang-1）in patients with acute ischemic stroke-large vessel occlusion（ALS-LVO）undergoing venous thrombolytic bridging stent thrombectomy．Methods A total of 80 patients with ALS-LVO from January 2019 to May 2021 were selected as the study subjects,treated with intravenous thrombolytic bridging stent thrombectomy,and their serum H-FABP and Ang-1 levels were measured before operation．After 90 days of follow-up,the patients were divided into good prognosis group（n=57）and poor prognosis group（n=23）．Results There were significant differences between the two groups in hypertension,coronary heart disease,atrial fibrillation,TOAST classification,collateral circulation,preoperative H-FABP,and preoperative Ang-1（P<0.05）．Multivariate logistic regression analysis showed that hypertension,atrial fibrillation,cardiogenic infarction type,collateral circulation of 0~1 grade,preoperative H-FABP≥10.0 ng/L,preoperative Ang-1<5.25 ng/mL were independent risk factors for poor prognosis of ALS-LVO patients treated with venous thrombolytic bridging stents．The AUC of preoperative serum H-FABP predicting poor prognosis 90 days after operation was 0.728（95%CI：0.368~0.918）,with sensitivity and specificity of 66.68% and 58.92% respectively．The AUC of preoperative serum Ang-1 predicting poor prognosis 90 days after surgery was 0.773（95%CI：0.592~1.129）,with sensitivity and specificity of 70.35% and 63.92% respectively．The AUC predicted by H-FABP combined with Ang-1 for poor prognosis 90 days after operation was 0.854（95%CI：0.652~0.957）,and the sensitivity and specificity were 77.18% and 71.82% respectively．Conclusions The prognosis of patients with ALS-LVO treated with intravenous thrombectomy bridging stent thrombectomy is affected by many risk factors,among which preoperative serum H-FABP and Ang-1 are promising prognostic factors．

目的 观察程序性死亡受体1（PD-1）联合细胞毒性T淋巴细胞相关蛋白4（CTLA-4）双免疫疗法对改善晚期乳腺癌近期疗效及远期预后的影响。方法 选择2020年5月—2022年5月商丘市第一人民医院收治的124例晚期乳腺癌患者为研究对象,经随机数字表法将其分为对照组（60例）和观察组（64例）,对照组予以常规PD-1单抗免疫疗法治疗,观察组采用PD-1联合CTLA-4双免疫疗法治疗,比较2组患者治疗前后肿瘤标志物水平、治疗后病灶缓解情况,对所有患者开展为期1年随访,统计并对比2组的不良反应发生情况及远期生存情况。结果 治疗前,2组患者的肿瘤标志物水平比较差异均无统计学意义（均P>0.05）;治疗后,观察组的癌胚抗原为（3.36±0.17）ng/mL,糖类抗原15-3为（25.33±5.28）U/mL,糖类抗原19-9为（38.77±5.62）U/mL,均低于对照组[（5.27±1.36）ng/mL、（28.44±5.18）U/mL、（41.25±5.46）U/mL,均P<0.05]。治疗后,观察组的完全缓解率为21.88%（14/64）,部分缓解率为31.25%（20/64）,病情稳定率为37.50%（24/64）,均高于对照组[8.33%（5/60）、13.33%（8/60）、23.33%（14/60）],肿瘤生长率为（30.27±5.18）%,肿瘤超进展率为6.25%（4/64）,均低于对照组[（33.49±5.32）%、18.33%（11/60）,均P<0.05]。治疗后,观察组的不良反应发生率为34.38%（22/64）,略高于对照组33.33%（20/60）,组间比较差异无统计学意义（P>0.05）;观察组的中位无进展生存期为（9.33±2.25）月,中位总生存期为（10.76±3.32）月,均高于对照组[（7.25±2.31）月、（7.41±1.62）月,均P<0.05]。结论 PD-1联合CTLA-4双免疫疗法能有效改善晚期乳腺癌的近期疗效及远期预后,此疗法未明显增加不良反应发生风险,安全性高。

Objective To observe the effect of programmed cell death protein-1（PD-1）combined with cytotoxic T lymphocyte-associated antigen-4（CTLA-4）dual immunotherapy on the short-term efficacy and long-term prognosis of advanced breast cancer．Methods A total of 124 patients with advanced breast cancer who were admitted to the First People's Hospital of Shangqiu City from May 2020 to May 2022 were selected as the research objects．They were randomly divided into the control group（60 cases）and the observation group（64 cases）by the method of random number table．The control group was treated with conventional PD-1 monoclonal antibody immunotherapy,and the observation group was treated with PD-1 combined with CTLA-4 double immunotherapy．The levels of tumor markers before and after treatment and the focal remission after treatment were compared between the two groups．All patients were followed up for one year,the incidence of adverse reactions and long-term survival between the two groups were compared．Results Before treatment,there was no statistically significant difference in the levels of tumor markers between two groups（all P>0.05）．After treatment,the carcino-embryonic antigen content of the observation group was（3.36±0.17）ng/mL,CA153 was（25.33±5.28）U/mL,and CA199 was（38.77±5.62）U/mL,which were lower than those of the control group [（5.27±1.36）ng/mL,（28.44±5.18）U/mL,（41.25±5.46）U/mL,all P<0.05]．After treatment,the complete remission rate of the observation group was 21.88%（14/64）,partial remission rate was 31.25%（20/64）,and stable disease rate was 37.50%（24/64）,all higher than those of the control group [8.33%（5/60）,13.33%（8/60）,23.33%（14/60）];tumor growth rate of the observation group was（30.27±5.18）%,hyper progressive disease rate was 6.25%（4/64）,both lower than those of the control group [（33.49±5.32）%,18.33%（11/60）,both P<0.05]．After treatment,the incidence of adverse reactions in the observation group was 34.38%（22/64）,slightly higher than that in the control group 33.33%（20/60）（P>0.05）．The median progression free survival of the observation group was（9.33±2.25）months,and the median overall survival was（10.76±3.32）months,both higher than those of the control group [（7.25±2.31）months and（7.41±1.62）months]（P<0.05）．Conclusions PD-1 combined with CTLA-4 dual immunotherapy can effectively improve the short-term efficacy and long-term prognosis of advanced breast cancer．This therapy does not significantly increase the risk of side effects,which is safe．

目的 研究益生菌结合肠内营养(enteral nutrition,EN)干预纠正缺血急性脑梗死(acute cerebral infarction,ACI)患者肠道菌落紊乱的作用及对患者预后的影响。方法 将97例无法自主进食的ACI患者根据治疗方法不同分为观察组(采用益生菌结合EN进行营养支持)和对照组(单纯EN为营养支持)进行治疗,疗程30 d,比较2组肠道菌落生长情况、患者营养水平、临床疗效及预后。结果 治疗后,2组双歧杆菌、肠球菌、大肠杆菌数量先降低后升高,2相邻时间点之间差异显著(P<0.05),2组乳酸杆菌数量持续升高,观察组各时间点之间差异显著(P<0.05),对照组治疗第7 d开始有明显差异(P<0.05),且治疗第7 d后观察组双歧杆菌、肠球菌、大肠杆菌数量高于对照组,差异有统计学意义(P<0.05),治疗第14 d后,观察组乳酸杆菌数量高于对照组,差异有统计学意义(P<0.05);治疗后,观察组体质量指数(body mass index,BMI)、肱三头肌皮皱厚度(triceps skinfold thinkness,TSF)、上臂肌围(arm muscle circumference,AMC)及血红蛋白(hemoglobin,HB)明显降低(P<0.05),对照组BMI、TSF、AMC、HB、白蛋白(albumin,ALB)及三酰甘油(triglyceride,TG)均明显降低(P<0.05),且观察组BMI、TSF、AMC、HB、ALB及TG高于对照组,差异有统计学意义(P<0.05);观察组治疗过程中腹胀、腹泻发生率低于对照组,差异有统计学意义(P<0.05);治疗后2组APACHEⅡ评明显降低(P<0.05),且观察组APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05);治疗后观察组日常生活活动能力(activities of daily life,ADL)评分高于对照组,ADL分级优于对照组,差异有统计学意义(P<0.05)。结论 益生菌结合EN治疗可有效纠正患者肠道菌落平衡,保护胃肠道功能,从而改善机体营养水平,提高ACI治疗效果,改善患者预后。

目的 分析CT+MRI在原发性肝癌诊断与介入治疗预后评估中的临床意义。方法 选定本院2019年1月—2021年1月住院治疗的150例原发性肝癌患者,入院后均接受介入治疗,分别予以CT、MRI检查,将手术病理检查结果作为本次研究的金标准,比较CT、MRI、CT+MRI诊断效能,Kappa检验CT、MRI、CT+MRI与金标准的一致性,比较CT、MRI、CT+MRI介入术后病灶检出率。结果 CT+MRI诊断准确率(98.67%)、特异度(75.00%)、灵敏度(99.32%)均高于CT(86.00%、25.00%、87.67%)、MRI(90.67%、91.78%、50.00%),P＜0.05(差异均有统计学意义),CT+MRI与金标准的一致性较好(Kappa值为0.779),CT、MRI与金标准的一致性一般(Kappa值为0.527、0.596)。CT+MRI介入术后病灶总检出率(12.00%)高于CT(2.00%)、MRI(4.00%),P＜0.05(差异有统计学意义)。结论 CT+MRI可提高原发性肝癌患者介入术后病灶检出率,弥补了单一CT、MRI检查的不足。

Objective To evaluate the clinical significance of CT + MRI scans in diagnosis of primary liver cancer and prognosis evaluation after interventional therapy. Methods A total of 150 cases of patients with primary liver cancer admitted to our hospital from January 2019 to January 2021 were selected. They all received interventional treatment, and were examined by CT and MRI. The results of pathological examination were taken as the gold standard in this study to compare the diagnostic efficacy of CT, MRI and CT+MRI.Kappa value was used to compare the consistency of CT, MRI, CT+MRI scans with gold standard, and compared the detection rate of lesions after CT, MRI and CT+MRI interventional surgery. Results The diagnostic accuracy (98.67%), specificity (75.00%) and sensitivity (99.32%) of CT + MRI scans were higher than those of CT (86.00%, 25.00%, 87.67%) and MRI scans (90.67%, 91.78%, 50.00%),P<0.05 (which differences were statistically significant). The consistency of CT + MRI scans with gold standard was good (kappa value was 0.779), but the consistency of CT/MRI scans with gold standard were not satisfying (kappa value were 0.527, 0.596). The total detection rate of lesions after CT + MRI interventional surgery (12.00%) was higher than that of CT (2.00%) and MRI (4.00%, which P<0.05). Conclusion CT + MRI scans can improve the detection rate of lesions in patients with primary liver cancer after interventional therapy, and make up for the deficiency of only CT or MRI scans.

目的 探讨急性心肌梗死患者细胞色素P450酶基因(cytochrome P450,family 2,subfamily C,polypeptide 19,CYP2C19)多态性与高敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin- 6,IL-6)及临床预后的相关性。方法 选取2019年5月—2020年5月入住我院心血管内科的急性心肌梗死患者182例作为研究对象,研究对象均接受经皮冠脉介入术,采取RT-PCR方法进行外周全血CYP2C19基因多态性的检测,并进行分组。口服阿司匹林300 mg和氯吡格雷300 mg后次日,测定血中hs-CRP和IL-6含量,治疗后12个月内,随访主要心血管不良事件。结果 182例急性心肌梗死患者中,快代谢组(CYP2C19*1/*1)患者最多,为78例(42.8%);中等代谢组(CYP2C19*1/*2、CYP2C19*1/*3),为65例(35.7%);慢代谢型组(CYP2C19*2/*2、CYP2C19*2/*3、CYP2C19*3/*3)最少,为39例(21.5%)。与快代谢组比较,中代谢组及慢代谢组hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05);与中代谢组比较,慢代谢组患者hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05)。CYP2C19基因型与hs-CRP及IL-6呈正相关(r=0.163、0.175,P<0.05)。中代谢组、慢代谢组患者1年内主要心血管不良事件发生率高于快代谢组患者(P<0.05)。结论 CYP2C19基因型与hs-CRP及IL-6具有相关性,CYP2C19基因型为中代谢型和慢代谢型能够激活机体炎症反应,影响急性心肌梗死患者的临床预后。

Objective To explore the correlation of cytochrome P450 gene (CYP2C19) polymorphism with hypersensitive C-reaction protein (hs-CRP), interleukin-6 (IL-6) and prognosis in patients with acute myocardial infarction (AMI). Methods A total of 182 patients with AMI admitted to cardiology department from May 2019 to May 2020 were selected as the research objects, all subjects underwent percutaneous coronary intervention (PCI), and CYP2C19 gene polymorphism in peripheral blood was detected by RT-PCR, which was grouping basis. One day after taking aspirin 300 mg and clopidogrel 300 mg orally, the levels of hs-CRP and IL-6 in patients' plasma were measured. The major adverse cardiovascular events (MACE) were followed up for 12 months after treatment. Results Among 182 patients with AMI, 78 patients (42.8%) were in the fast metabolism group (CYP2C19*1/*1), 65 patients (35.7%) in medium metabolism group (CYP2C19*1/*2, CYP2C19*1/*3), 39 patients (21.5%) in the slow metabolism group (CYP2C19*2/*2, CYP2C19*2/*3, CYP2C19*3/*3).Compared with the fast metabolism group, hs-CRP and IL-6 levels in the medium and slow metabolism group were significantly higher (P<0.05); compared with the medium metabolism group, hs-CRP and IL-6 levels in the slow metabolism group were significantly increased (P<0.05). CYP2C19 genotype was positively correlated with hs-CRP and IL-6 levels (r=0.163, 0.175,P<0.05). The incidences of MACE in the medium and slow metabolism groups were higher than that in the fast metabolism group (P<0.05). Conclusion CYP2C19 genotypes were associated with hs-CRP and IL-6 levels. Medium and slow metabolism types of CYP2C19 gene can activate the inflammatory response and affect the clinical prognosis of patients with AMI.

目的 分析CT肺动脉栓塞指数(PAOI)与急性肺栓塞(APE)患者右心功能与预后的相关性。方法 以收治的86例疑似患者为研究对象,均行CT肺动脉成像(CTPA)检查,共60例APE患者,依据患者病情严重程度分为轻度、中度与重度,而无APE患者26例(对照组),分析左右心室最大短轴内径(RVd/LVd)、左右心室最大截面积比(RVA/LVA)、右心室短轴最大直径(RVMSA)、左心室短轴最大内径(LVMSA)、主肺动脉直径(MPAd)、上腔静脉直径(SVCd)、奇静脉直径(AZd)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)以及动脉血氧饱和度(SaO₂)与PAOI的相关性,并分析患者预后情况。结果 经比较,中、重度患者RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平高于轻度患者,而LVMSA低于轻度患者(P<0.05);且重度患者RVd/LVd、RVMSA水平高于中度,而RVA/LVA、LVMSA、MPAd与AZd水平比较无意义(P>0.05);3组SVCd水平比较P>0.05,其他参数指标比较差异明显(P<0.05);APE患者的PaO₂、PaCO₂以及SaO₂水平随着患者病情的加重呈现出逐渐下降趋势,且3组患者的PaO₂对比差异有统计学意义(P<0.05);PaO₂、PaCO₂和SaO₂与PAOI均呈负相关,且仅有PaO₂的差异存在统计学意义(P<0.05);POAI对APE患者的死亡有着一定的预测价值(P<0.05),最佳切点值58.91%,敏感度为85.29%,特异度为89.93%,其他数据未见明显诊断预测价值(P>0.05)。故RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平与PAOI成正相关,而LVMSA水平与PAOI成负相关,与SCVd无关。结论 PAOI与APE患者的右心功能各参数以及动脉血气各参数均有密切关联性,可将其作为患者预后评估的有效指标。

目的 探究血清脂滴蛋白-5表达水平与ST段抬高型心肌梗死(STEMI)老年患者冠状动脉病变和预后的相关性。方法 对2016年1月—2018年1月的100例STEMI老年患者进行研究,所有患者于入院次日晨起空腹状态下检测血清脂滴蛋白-5表达水平,根据中位值分成高表达组(对照组)和低表达组(观察组)各50例,比较不同表达水平患者的冠状动脉病变支数、死亡率和不良事件发生率,分析血清脂滴蛋白-5表达水平与冠状动脉病变血管支数和预后的相关性。结果 2组冠状动脉血管单支、双支病变概率对比无差异(P>0.05);观察组3支病变概率为48.00%,高于对照组的24.00%,数据有差异(P<0.05);观察组治疗1个月、半年和3年后的死亡率分别为18.00%、28.00%和36.00%,高于对照组的2.00%、6.00%和12.00%,存在数据差异(P<0.05);观察组治疗1个月、半年和3年后的主要心血管不良事件发生率分别为30.00%、40.00%和48.00%,数据对比有差异(P<0.05);血清脂滴蛋白-5表达水平与病变支数为负相关关系,与近远期预后为正相关关系(r=-0.754,P=0.008;r=0.816,P=0.005)。结论 血清脂滴蛋白-5表达水平与STEMI老年患者冠脉病变严重性和近远期预后密切相关:表达水平低,病情越严重,预后越差。

目的 使用TCGA数据库,探索DNA甲基化位点对肺腺癌的预后影响。方法 使用TCGA数据库,获取肺腺癌病人癌和癌旁组织甲基化表达数据、基因表达数据及临床数据;将人群分为探索组和验证组,使用LASSO在探索人群中筛选对肺腺癌预后有影响的甲基化位点;受试者工作特征曲线用于评估甲基化位点预测效果,并进一步在验证人群中验证。结果 在TCGA数据库中筛选出158个癌和癌旁组织差异表达且与所在基因mRNA表达显著相关的甲基化位点,经LASSO回归分析,cg19378330与肺腺癌预后相关。甲基化位点水平高于中位数的患者,归入高风险组,甲基化位点水平低于中位数的为低风险组。结果发现与低风险组相比,高风险组的死亡风险比低风险组增加了38%(OR=1.38,95% CI=1.16～2.69)。在探索阶段人群中其曲线下面积为0.80(95% CI=0.73～0.88),灵敏度为86.2%。验证人群中也表现出类似结果。结论 甲基化位点cg19378330与肺腺癌具有较显著的关联性,且可以对肺腺癌的风险进行有效的预测。

Objective Using the TCGA database to explore the prognostic effects of DNA methylation sites on lung adenocarcinoma. Methods TCGA database was used to collecting DNA methylation data, gene expression data and clinical data of lung adenocarcinoma patients. The population were divided into the exploratory group and the validation group. The LASSO regression analysis was used to screen the methylation sites associated with the prognosis of lung adenocarcinoma in the exploratory group. Receiver operating characteristic curve was used to evaluate the prediction effect of the model, and further verified in the validation population. Results A total of 158 methylation sites with differential expression and significant correlation with the mRNA expression of the corresponding gene were screened from the TCGA database. With LASSO regression analysis, the DNA methylation sites associated with prognosis of lung adenocarcinoma were cg19378330. Those patients with levels above the median methylation site were assigned to the high-risk group, while those with levels below the median methylation site were assigned to the low-risk group. Patients' death risk in the high-risk group were 38% higher than those in the low-risk group (OR=1.38, 95%CI=1.16-2.69). The area under the curve was 0.80 (95%CI=0.73-0.88) and the sensitivity was 86.2% in the exploratory stage population.Similar results were seen in the validation population. Conclusions The DNA methylation site cg19378330 was significantly associated withthe prognosisof lung adenocarcinoma, and could effectively predict the risk of lung adenocarcinoma.

目的 探究血清降钙素原(PCT)联合阴离子隙(AG)检测在脓毒症患者预后中预测价值。方法 选取2019年1月—2021年1月于我院治疗117例毒症患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(78例)和死亡组(39例),对比2组患者一般资料,采用多因素分析其高危因素,应用ROC曲线确定曲线下面积,评估血清PCT联合AG检测对该类患者预后的预测价值。结果 2组患者一般资料对比,年龄、中性粒细胞计数、血清C反应蛋白(CRP)、PCT、AG、APACHEⅡ评分差异有统计学意义(P<0.05);年龄、CRP、PCT、AG水平是该类死亡的危险因素;ROC曲线分析结果显示,血清PCT曲线下面积为0.737,最佳截断值为9.595;AG曲线下面积为0.791,最佳截断值为21.695;血清PCT联合AG检测曲线下面积为0.933,最佳截断值为1.3442。结论 血清PCT联合AG检测对脓毒症患者预后具有较高的预测价值。

Objective To investigate the predictive value of serum procalcitonin (PCT) combined with anion gap (AG) detection on the prognosis of patients with sepsis. Methods One hundred and seventeen patients with sepsis treated in our hospital from January 2019 to January 2021 were selected as study subjects and divided into survival group (78 patients) and death group (39 patients) according to their prognosis at 28 d of admission. The general data of the two groups was compared, multi-factor Logistic analysis of high-risk factors of sepsis patients was performed, area under the ROC curve was applied to assess the predictive value of serum PCT combined AG detection on the prognosis of sepsis patients. Results After comparing the general data of the two groups, the differences in age, neutrophil count, C-reactive protein (CRP), PCT, AG and APACHE II scores were statistically significant (P<0.05); multi-factor Logistic regression analysis showed that age, CRP, PCT and AG levels were risk factors for death in sepsis patients; the results of ROC curve analysis showed that the area under the curve of serum PCT was 0.737, with an optimal cut-off value of 9.595; the area under the AG curve was 0.791, with an optimal cut-off value of 21.695;the area under the curve of serum PCT combined with AG was 0.933, and the optimal cut-off value was 1.3442. Conclusions Serum PCT combined with AG assay had a high predictive value for the prognosis of patients with sepsis.

目的 对儿童重症肺炎支气管肺泡灌洗液(BALF)进行病原学分析及疾病预后的分析。方法 本研究选取2019年3月—2020年12月在我院儿科住院并进行肺泡灌洗治疗的40例重症肺炎患儿作为研究对象。通过对这些患儿在感染急性期肺泡灌洗液中的细菌、真菌、肺炎支原体等进行病原学检查以及T 淋巴细胞亚群的检测,了解台山地区儿童重症肺炎病原体情况及耐药性、T淋巴细胞亚群与疾病严重程度、预后评估的关系。结果 BALF病原学检测结果分析中,肺炎支原体27例,肺炎支原体+肺炎链球菌5例,肺炎支原体+中间葡萄球菌2例,肺炎支原体+铅黄肠球菌1例,肺炎支原体+嗜麦芽假单胞菌2例,病原菌阴性3例;本组病例血清T细胞亚群检测结果显示:大部分病例CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺水平有不同程度的下降。其中CD3⁺水平下降的有6例,CD4⁺水平下降的有16例,CD8+水平下降的有17例,CD4⁺、CD8⁺水平同时下降的有14例,CD3⁺、CD4⁺、CD8⁺水平同时下降的有4例;BALF细胞总数(3673.1±377.9)×10⁶ /L,巨噬细胞比例(23.6±17.6)%,淋巴细胞(22.1±16.2)%,中性粒细胞(46.5±24.8)%。结论 病原学分析儿童重症肺炎BALF的主要病原菌为肺炎支原体,血清T细胞亚群检测大多表现为CD4⁺、CD8⁺水平下降。

Objective To analyze the etiology of bronchoalveolar lavage fluid and prognosis of children with severe pneumonia. Methods In this study, 40 children with severe pneumonia who were hospitalized in the pediatrics department of our hospital and underwent alveolar lavage treatment from March 2019 to December 2020 were selected as the research objects. Through the detection of pathogens such as bacteria, fungi, Mycoplasma pneumoniae and T lymphocyte subsets of these children in the acute phase of infection, we can understand the pathogens and drug resistance of children with severe pneumonia in Taishan area and the relationship among drug resistance, T lymphocyte subsets and disease severity and prognosis assessment. Results In the analysis of the BALF pathogenic test results, there were 27 cases with Mycoplasma pneumoniae, 5 cases with Mycoplasma pneumoniae+Streptococcus pneumoniae, 2 cases with Mycoplasma pneumoniae+Staphylococcus intermedius, 1 case with Mycoplasma pneumoniae+Enterococcus casseliflavus, 2 cases with Mycoplasma pneumoniae+Pseudomonas maltophilia and 3 cases were pathogenic bacteria negative. The test results of serum T cell subsets of these cases showed that most of the cases had different degrees of decline in the levels of CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺. Among them, CD3⁺ levels decreased in 6 cases, CD4⁺ levels decreased in 16 cases, CD8⁺ levels decreased in 17 cases, CD4⁺ and CD8⁺ levels decreased in 14 cases, and CD3⁺, CD4⁺, and CD8⁺ levels decreased in 4 cases; total cell number of BALF was (3 673.1±377.9)×10⁶/L, the proportion of macrophages was (23.6±17.6)%, lymphocytes had (22.1±16.2)%, and neutrophils had (46.5±24.8)%. Conclusions Pathogenic analysis showed that the main pathogen of BALF in children with severe pneumonia is Mycoplasma pneumoniae, and the detection of serum T cell subsets mostly showed a decrease in CD4⁺ and CD8⁺ levels.