创伤输血后感染患者血清T淋巴细胞表达情况及危险因素分析

doi:10.19871/j.cnki.xfcrbzz.2024.02.010

摘要/Abstract

摘要： 目的分析创伤输血后感染患者血清T淋巴细胞变化情况及其是否与患者发生感染有关,并分析患者感染的危险因素,以期为患者感染预防及是否需要进行免疫监测提供参考。方法纳入2019年1月至2023年5月青海省第五人民医院收治的创伤输血病例126例,检测患者输血前后血清T淋巴细胞水平,根据患者是否发生感染分组为感染组（43例）、未感染组（83例）,比较两组血清T淋巴细胞水平,并收集患者年龄、性别、创伤类型、是否使用免疫抑制剂、红细胞保存时间等一般资料进行单因素分析,将其中有统计学意义的资料纳入多因素Logistic回归分析模型完成创伤输血后感染的危险因素分析。结果输血后患者CD3⁺T淋巴细胞、CD4⁺T淋巴细胞、CD4⁺/CD8⁺水平显著降低,CD8⁺T淋巴细胞显著升高（P<0.05）;感染组患者CD3⁺T淋巴细胞、CD4⁺T淋巴细胞、CD4⁺/CD8⁺水平显著低于未感染组,CD8⁺T淋巴细胞水平显著高于未感染组（P<0.05）;一般资料的单因素分析中感染组患者多发伤、使用免疫抑制剂、接受消化道脱污染治疗、平均红细胞保存时间≥14d、红细胞输入总单位数≥7个占比显著高于未感染组（P< 0.05）,其余吸烟、酗酒、年龄、性别、平均血小板保存时间、是否合并糖尿病、血小板输入总单位数等资料无显著差异（P>0.05）;多因素Logistic回归分析提示CD8⁺T淋巴细胞升高、多发伤、使用免疫抑制剂、接受消化道脱污染治疗、平均红细胞保存时间≥14d、红细胞输入总单位数≥7个是创伤输血患者感染的独立危险因素,CD3⁺T淋巴细胞、CD4⁺T淋巴细胞、CD4⁺/CD8⁺增加为保护因素。结论创伤输血后易对患者免疫功能产生影响,创伤输血后感染患者较未感染患者T淋巴细胞亚群紊乱现象更明显,创伤输血患者需重视其免疫监测,预防感染。

关键词: T淋巴细胞, 创伤, 输血, 感染, 危险因素

Abstract: Objective To analyze the changes of serum T lymphocytes in patients with infection after trauma blood transfusion and whether it is related to the patient's infection, and briefly analyze the risk factors of infection in such patients, in order to provide reference for infection prevention and whether immune monitoring is needed in such patients. Method 126 trauma blood transfusion cases admitted to Qinghai Provincial Fifth People's Hospital from January 2019 to May 2023 were included. The patients' serum T lymphocyte levels were measured before and after blood transfusion. According to whether the patients were infected, they were divided into infection group (43 cases) and uninfected group (83 cases), the serum T lymphocyte levels of the two groups were compared, and general information such as patient age, gender, trauma type, whether immunosuppressants were used, and red blood cell storage time were collected for single-factor analysis, and statistically significant results were analyzed. The data were included in the Logistic regression analysis model to complete the risk factor analysis of infection after trauma blood transfusion. Result After blood transfusion, the levels of CD3⁺T lymphocytes, CD4⁺T lymphocytes, and CD4⁺/CD8⁺ in patients were significantly reduced, while CD8⁺T lymphocytes were significantly increased (P<0.05); in the infection group, the levels of CD3⁺T lymphocytes, the levels of CD4⁺T lymphocytes and CD4⁺/CD8⁺ were significantly lower than those of the uninfected group, and the levels of CD8⁺T lymphocytes were significantly higher than those of the uninfected group (P<0.05); in the single-factor analysis of other general data, patients in the infected group had multiple injuries, use the proportion of immunosuppressants, receiving gastrointestinal decontamination treatment, average red blood cell storage time ≥14 days, and the total number of red blood cell transfusion units ≥7 was significantly higher than that of the uninfected group (P<0.05). The rest were smoking, alcohol abuse, age, gender, there was no significant difference in the average platelet storage time, whether combined with diabetes, and the total number of platelet transfusion units (P>0.05). Logistic regression analysis showed that CD8⁺T lymphocytes elevated, multiple injuries, use of immunosuppressants, and gastrointestinal decontamination treatment, average red blood cell storage time ≥14 days, and total number of red blood cell transfusion units ≥7 are independent risk factors for infection in trauma blood transfusion patients (OR>1, P<0.05), CD3⁺T lymphocytes, CD4⁺T lymphocytes, CD4⁺/CD8⁺ is a protective factor (OR<1, P<0.05). Conclusion After trauma blood transfusion, it is easy to have an impact on the patient's immune function. Infected patients after trauma blood transfusion have more obvious disorder of T lymphocyte subsets than uninfected patients. Patients with trauma blood transfusion need to pay attention to their immune monitoring to prevent infection.

Key words: T lymphocytes, Trauma, Blood transfusion, Infection, Risk factors

中图分类号:

R457.1

李鑫, 王云云, 石有贵, 陈启明. 创伤输血后感染患者血清T淋巴细胞表达情况及危险因素分析[J]. 新发传染病电子杂志, 2024, 9(2): 50-54.

Li Xin, Wang Yunyun, Shi Yougui, Chen Qiming. Analysis of serum T lymphocyte expression and risk factors in patients with infection after trauma transfusion[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(2): 50-54.

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