CD4+ T淋巴细胞计数在慢性肾衰竭患者衰弱状态评价中的监测意义

doi:10.3969/j.issn.1004-583X.2022.03.008

摘要/Abstract

摘要：

目的探索CD4⁺ T淋巴细胞计数在慢性肾功能衰竭衰弱状态患者营养监测及预后判断中的意义。方法通过青岛大学附属医院医渡云数据库筛选出2013年至2020年符合条件的慢性肾功能衰竭患者381例。于入院时检测CD4⁺ T淋巴细胞计数及与免疫、营养相关指标,并进行急性生理和慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭估计(SOFA)评分、衰弱评分(结合埃德蒙顿衰弱量表拟定适于慢性肾功能衰竭患者的衰弱评分)。依据患者入院时CD4⁺ T淋巴细胞计数,将所有入选者分为3组:A组67例(CD4⁺ T淋巴细胞计数<200 cells/μl),B组175例(200 cells/μl≤CD4⁺ T淋巴细胞计数<544 cells/μl),C组139例(CD4⁺ T淋巴细胞计数≥544 cells/μl)。分析CD4⁺ T淋巴细胞计数与免疫、营养相关指标、SOFA评分、APACHEⅡ评分、衰弱评分的相关性,绘制Kaplan-Meier生存曲线。结果本研究中,衰弱患者总体占比为36.5%(139/381),而当CD4⁺ T淋巴细胞计数低于正常值时(<544 cells/μl),衰弱患者占比高达53.7%(130/242),CD4⁺ T淋巴细胞计数为正常范围时,衰弱患者占比仅为6.5%(9/139)。入院时,3组一般资料差异无统计学意义(均P>0.05),血清总蛋白、前白蛋白、白蛋白、APACHEⅡ评分、SOFA评分、衰弱评分比较,差异有统计学意义(均P<0.01)。3组生存率差异有统计学意义(P<0.01)。结论慢性肾功能衰竭患者的衰弱状态不容忽视,衰弱患者的营养状态与免疫状态相互影响。通过监测CD4⁺ T淋巴细胞计数,及时改善患者营养状态可提高患者免疫功能,从而改善预后。

关键词: 肾功能衰竭,慢性, 衰弱, 营养不良, 免疫减弱宿主, CD4⁺ T淋巴细胞计数

Abstract:

Objective To evaluate the significance of CD4⁺ T lymphocyte count in the evaluation of nutrition and prognosis of chronic renal failure in patients. Methods Totally 381 chronic renal failure patients were selected from YIDUCLOUD database of the Affiliated Hospital of Qingdao University during 2013 to 2020 for systematic analysis. CD4⁺ T lymphocyte counts and indicators related to immunity and nutrition of those patients were detected on admission, and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) score, and frailty score combined with Edmonton Frailty Scale were performed. As CD4⁺ T lymphocytes count of admission, patients were divided into three groups: A group of 67 cases (CD4⁺ T lymphocyte count< 200 cells/μl), B group of 175 cases (200 cells/μl≤CD4⁺ T lymphocyte count <544 cells/μl), and C group of 139 cases (CD4 ⁺ T lymphocyte count≥544 cells/μl). The correlation between CD4⁺ T lymphocyte counts, immune, nutrition-related indicators, SOFA score, APACHE Ⅱ score, and frailty score were analyzed. Kaplan-Meier survival curve was drawn. Results In this study, the overall proportion of frail patients was 36.5%(139/381), the proportion of frail patients was as high as 53.7%(130/242) at the count of CD4 ⁺ T lymphocytes <544 cells/μl, and the frail patients accounted for only 6.5% (9/139) at the count in the normal range. There was no significant difference in general data of admission among groups (all P>0.05), but the differences in serum total protein, prealbumin, albumin, APACHE Ⅱ score, SOFA score, and frailty score were statistically significant (all P<0.01). The difference in survival rate among the three groups was statistically significant (P<0.01). Conclusion Due to interactions of nutritional and immune status in chronic renal failure patients, the frail status cannot be ignored. The immune status of the patient can be improved by monitoring CD4 ⁺ T lymphocyte count and timely improving nutritional status, thereby improving the prognosis.

Key words: kidney failure,chronic, frailty, malnutrition, immunocompromised host, CD4⁺ T lymphocytes count

中图分类号:

R692.5

李莹莹, 李婷, 张铭, 范明华, 邢广群. CD4⁺ T淋巴细胞计数在慢性肾衰竭患者衰弱状态评价中的监测意义[J]. 临床荟萃, 2022, 37(3): 243-247.

Li Yingying, Li Ting, Zhang Ming, Fan Minghua, Xing Guangqun. Monitoring significance of CD4⁺ T lymphocyte count on evaluating frailty status of chronic renal failure in patients[J]. Clinical Focus, 2022, 37(3): 243-247.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.03.008

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I3/243

图/表 8

参考文献 27

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项目	A组(n=67)	B组(n=175)	C组(n=139)	统计值	P值
年龄	60.00(54.09,62.87)	65.00(59.97,64.99)	58.00(55.78,61.19)	H=1.290	0.069
性别[例(%)]
男女	35(52.2) 32(47.8)	86(49.1) 89(50.9)	77(55.4) 62(44.6)	χ²=2.567	0.277
透析方式[例(%)]
血液透析腹膜透析	19(28.4) 11(16.4)	78(44.6) 22(12.6)	43(30.9) 22(15.8)	χ²=12.704	0.122
原发病[例(%)]
慢性肾小球肾炎	22(32.8)	58(33.1)	53(38.1)	χ²=0.125	0.940
糖尿病肾病	21(31.3)	59(33.7)	45(32.4)	χ²=0.163	0.922
高血压肾病	16(23.9)	28(16.0)	23(16.6)	χ²=2.080	0.354
痛风性肾病	2(3.0)	2(1.1)	2(1.4)	χ²=1.052	0.591
梗阻性肾病	1(1.5)	7(4.0)	5(3.6)	χ²=0.967	0.617
多囊肾	0(0)	8(4.6)	2(1.4)	χ²=4.943	0.084
药物所致肾衰竭	1(1.5)	3(1.7)	1(0.7)	χ²=0.537	0.764
其他原因	4(6.0)	10(5.7)	8(5.8)	χ²=0.017	0.991

项目	A组(n=67)	B组(n=175)	C组(n=139)	统计值	P值
年龄	60.00(54.09,62.87)	65.00(59.97,64.99)	58.00(55.78,61.19)	H=1.290	0.069
性别[例(%)]
男女	35(52.2) 32(47.8)	86(49.1) 89(50.9)	77(55.4) 62(44.6)	χ²=2.567	0.277
透析方式[例(%)]
血液透析腹膜透析	19(28.4) 11(16.4)	78(44.6) 22(12.6)	43(30.9) 22(15.8)	χ²=12.704	0.122
原发病[例(%)]
慢性肾小球肾炎	22(32.8)	58(33.1)	53(38.1)	χ²=0.125	0.940
糖尿病肾病	21(31.3)	59(33.7)	45(32.4)	χ²=0.163	0.922
高血压肾病	16(23.9)	28(16.0)	23(16.6)	χ²=2.080	0.354
痛风性肾病	2(3.0)	2(1.1)	2(1.4)	χ²=1.052	0.591
梗阻性肾病	1(1.5)	7(4.0)	5(3.6)	χ²=0.967	0.617
多囊肾	0(0)	8(4.6)	2(1.4)	χ²=4.943	0.084
药物所致肾衰竭	1(1.5)	3(1.7)	1(0.7)	χ²=0.537	0.764
其他原因	4(6.0)	10(5.7)	8(5.8)	χ²=0.017	0.991

组别	ALB (g/L)	PAB (mg/L)	TP (g/L)	T淋巴细胞计数 (×10⁹/L)	SCr (μmol/L)	估算肾小球滤过率 [ml/ (min·1.73 m²)]	TC (mmol/L)	LDL-C (mmol/L)
A组	26.25 (23.78,29.49)	179.00 (134.98,228.12)	53.50 (39.13,91.61)	0.61 (0.24,1.76)	541.60 (415.23,659.40)	6.00 (5.32,10.68)	3.55 (2.83,4.98)	2.84 (2.18,17.57)
B组	31.60 (29.79,32.46)	219.00 (201.86,251.95)	60.40 (59.22,66.35)	0.90 (0.93,0.90)	521.50 (433.25,581.09)	6.00 (7.42,17.03)	4.2 (0.11,17.62)	2.70 (2.44,3.12)
C组	33.91 (34.25,40.94)	211.50 (197.56,246.38)	58.40 (56.66,64.57)	1.36 (1.31,1.65)	573.75 (485.04,645.62)	6.00 (6.25,9.75)	3.81 (3.57,4.89)	2.59 (2.51,3.73)
统计值	H=26.485	H=15.961	H=14.053	H=2.492	H=1.109	H=1.057	H=3.920	H=2.588
P值	<0.01	<0.01	<0.01	0.077	0.582	0.346	0.144	0.080

组别	ALB (g/L)	PAB (mg/L)	TP (g/L)	T淋巴细胞计数 (×10⁹/L)	SCr (μmol/L)	估算肾小球滤过率 [ml/ (min·1.73 m²)]	TC (mmol/L)	LDL-C (mmol/L)
A组	26.25 (23.78,29.49)	179.00 (134.98,228.12)	53.50 (39.13,91.61)	0.61 (0.24,1.76)	541.60 (415.23,659.40)	6.00 (5.32,10.68)	3.55 (2.83,4.98)	2.84 (2.18,17.57)
B组	31.60 (29.79,32.46)	219.00 (201.86,251.95)	60.40 (59.22,66.35)	0.90 (0.93,0.90)	521.50 (433.25,581.09)	6.00 (7.42,17.03)	4.2 (0.11,17.62)	2.70 (2.44,3.12)
C组	33.91 (34.25,40.94)	211.50 (197.56,246.38)	58.40 (56.66,64.57)	1.36 (1.31,1.65)	573.75 (485.04,645.62)	6.00 (6.25,9.75)	3.81 (3.57,4.89)	2.59 (2.51,3.73)
统计值	H=26.485	H=15.961	H=14.053	H=2.492	H=1.109	H=1.057	H=3.920	H=2.588
P值	<0.01	<0.01	<0.01	0.077	0.582	0.346	0.144	0.080

组别	APACHEⅡ评分(分)	SOFA评分(分)	衰弱评分(分)	死亡人数[例(%)]
A组	24.00(23.19,25.88)	18.00(17.51,18.96)	9.00(8.1,9.12)	11(0.16)
B组	16.00(14.56,15.91)^*	13.00(12.31,13.59)^*	5.00(4.78,5.44)^*	12(0.07)^*
C组	7.00(6.79,7.56)^*#	7.00(6.20,6.91)^*#	1.50(1.62,2.15)^*#	8(0.06)^*#
统计值	H=449.401	H=282.378	H=9.392	χ²=9.002
P值	<0.01	<0.01	<0.01	0.010