多发伤所致急性呼吸窘迫综合征早期免疫细胞动态变化与肺部感染的相关性研究

Objective: To explore the correlation between the dynamic changes of early immune cells in acute respiratory distress syndrome( ARDS) caused by multiple injuries and lung infection. Methods: Multiple injury patients with ARDS( 235 cases) admitted to the First Affiliated Hospital of Hunan University of Chinese Medicine from October 2017 to February 2023 were selected as the research subjects and included them in the training set; according to simple clinical pulmonary infection scores (sCPIS), they were divided into a pulmonary infection group (94 cases, >6 points) and an uninfected group (141 cases, ≤6 points). Another multiple injury patients with ARDS (78 cases) were selected to be included in the validation set to verify the effectiveness of the prediction model. Dynamic detection of lymphocytes were used flow cytometry. Compared and analyzed the clinical data of two groups of patients. Constructed a joint model and used Cox regression to analyze the relationship. Multi factor Logistic regression analysis of risk factors, construction of a simple risk scoring model and evaluation. Results: As the patient progresses, CD4+ and CD8+ first decrease and then increased, and the lowest stage was 3~15 d after onset; CD19+ was gradually increasing; CD16+ gradually decreased and fluctuated within a certain range. The joint model showed that for every 1 piece/μl longitudinal decrease in CD4+, CD8+, CD19+, and CD16+, the risk of pulmonary infection increased by 5.6%, 4.1%, 3.4% and 1.3%, respectively( P<0.05). Injury severity score( ISS), chest injury as the main factor, emergency surgery, acutephysiology and chronic health evaluation Ⅱ (APACHE Ⅱ), broncho-alveolar lavage fluid( BALF) sTREM-1 level, and CD4+, CD8+, and CD19+ level on the 15th day after onset all were independent influencing factors for the occurrence of pulmonary infection( P<0.05). The score of the simple risk scoring model is 0~36.7 points, which could be divided into three risk levels: low (<16 points), medium (16~22 points), and high risk (>22 points); there was no significant difference in the incidence of pulmonary infection between the two episodes of patients (P>0.05). The evaluation results showed that the predictive model has good discrimination. Conclusion: The fluctuation of immune cells will increase the risk of pulmonary infection in patients with multiple injuries ARDS; Baseline CD4+, CD8+, and CD19+ levels are independent influencing factors for the occurrence of pulmonary infection; controlling high-level immune cells and maintaining stability is crucial for improving prognosis. [ABSTRACT FROM AUTHOR]