2019 年第 9 期 第 14 卷

慢性肾脏病5期患者重症监护病房内感染及免疫功能和应激反应情况分析

Analysis of infection, immune function and stress response in patients with chronic kidney disease stage 5 in intensive care unit

作者：张利霞张巍

英文作者：

单位：046000长治医学院附属和济医院肾内科

英文单位：

关键词：慢性肾脏病；病原菌；免疫功能；应激反应

英文关键词：

• 摘要：

• 【摘要】目的    探讨慢性肾脏病5期（CKD5）患者重症监护病房（ICU）内感染及免疫功能和应激反应情况，为临床治疗提供参考。方法    以长治医学院附属和济医院2014年12月至2018年12月期间收治的CKD5 ICU内感染患者（感染组，n=60）为研究对象，采用法国生物梅里埃公司生产的全自动微生物鉴定系统VITEK2 Compact或飞行时间质谱进行病原菌鉴定。以ICU内未感染的CKD5患者（未感染组，n=90）和正常体检者（对照组，n=60）为对照。酶联免疫吸附测定法分析各组研究对象免疫功能和应激反应相关指标水平的变化。结果    60例CKD5患者ICU内感染病原菌中革兰阳性菌31株、占51.7%，革兰阴性菌22株、占36.7%，真菌7株、占11.7%。CKD5患者（感染组与未感染组）免疫球蛋白（Ig）A和IgG水平明显低于对照组，且感染组患者低于未感染组患者［（0.85±0.12）g/L比（1.45±0.49）g/L、（9.54±1.66）g/L比（12.80±3.09）g/L］；而IgM、白细胞介素2（IL-2）、IL-6、C反应蛋白（CRP）和降钙素原水平明显高于对照组，且感染组患者高于未感染组患者［（1.55±0.54）g/L比（0.80±0.16）g/L、（66±6）ng/L比（49±6）ng/L、（55±7）ng/L比（44±6）ng/L、（36.9±4.2）mg/L比（26.6±4.8）mg/L、（36±4）μg/L比（26±6）μg/L］，差异均有统计学意义（均P<0.05）。结论    CKD5患者ICU内容易受到感染病原菌感染，且能升高应激反应分子水平、影响机体免疫功能。

• 【Abstract】Objective    To observe the occurrence of infection and changes of immune function and stress response in patients with chronic kidney disease stage 5(CKD5) in intensive care unit(ICU). Methods    From December 2014 to December 2018, 60 CKD5 patients with infection staying in ICU at Heji Hospital Affiliated to Changzhi Medical College were enrolled as infection group. Pathogens of infection were identified by VITEK2 Compact(BioMerieux, France) or time-of-flight mass spectrometry. Ninety CKD5 patients without infection in ICU were enrolled as non-infection group. Sixty healthy people were enrolled as control group. Immune function and stress response indicators were detected by enzyme-linked immunosorbent assay. Results    Pathogen identification showed 31 strains of Gram-positive bacteria(51.7%), 22 strains of Gram-negative bacteria(36.7%) and 7 strains of fungi(11.7%). Levels of serum immunoglobulin(Ig)A and IgG in CKD5 patients(infection group and non-infection group) were significantly lower than those in control group; the levels in infection group were significantly lower than those in non-infection group［（0.85±0.12）g/L vs （1.45±0.49）g/L, （9.54±1.66）g/L vs （12.80±3.09）g/L］. Levels of serum IgM, interleukin-2(IL-2), IL-6, CRP and procalcitonin in CKD5 patients were significantly higher than those in control group; the levels in infection group were significantly higher than those in non-infection group［（1.55±0.54）g/L vs （0.80±0.16）g/L, （66±6）ng/L vs （49±6）ng/L, （55±7）ng/L vs （44±6）ng/L, （36.9±4.2）mg/L vs （26.6±4.8）mg/L, （36±4）μg/L vs （26±6）μg/L］(all P<0.05). Conclusion    ICU patients with CKD5 are susceptible to pathogens; pathogenic infection can aggravate stress response and cause immune dysfunction.