Clinical significance of immune function and immunomodulation in ventilator-associated pneumonia

Abstract

Objective To investigate the role of immune function and immunomodulation therapy and To evaluate the effect of immunomodulation therapy and prognosis in ventilator-associated pneumonia.Methods Choose ventilator-associated pneumonia (VAP) patients (complete cases) 40 cases from Jannural 2011 to March 2012 in intensive care unit (ICU) of Guiyang Medical University patients treated.and divided them into 2 groups according to the vesting:the survival group (24 cases)and the death group(16 cases).To evaluate the scores of clinical pulmonary infection score (CPIS) and immune function; Choose VAP patients (complete cases) 30 cases and randomly divided into ulinastatin treatment group (15 cases) and control group (15 cases),at onset of VAP and at 7days after onset to detect cytoactive of T-Lymphocyte Subsets with flow cytometry,and to detect.the serum level of IgA,IgM,IgG with immunol nephelometer.Choose 20 health people as heathy group.Results To compare p death group and survival group with heathy group,death of peripheral blood T lymphocytes CD3 +,CD4 +,CD8 + cell count,CD4+/CD8 +[(280.32 ± 169.58) × 106/L,(212.56 ± 122.99) × 106/L,(132.73 ± 56.74) × 106/L,1.48 ± 0.82]and the survival group [(485.05 ±209.18) × 106/L,(352.05 ± 116.41) × 106/L,(245.68 ±68.69) ×106/L,2.78 ± 1.04] was significantly lower than heathy group [(1183 ± 639.18) × 106/L,(631 ±321.64) × 106/L,(525 ± 221.67) × 106/L,2.78 ± 1.04],there was a significant difference(P ＜ 0.05).Death group of peripheral blood IgG [(10.76 ±4.52) g/L] was significantly lower than the survival group [(13.65 ± 6.34) g/L] and heathy group [(14.39 ± 7.47) g/L],there was a significant difference (P ＜0.05).Before treatment,there was no difference in all biomarkers between two group,after immunomodulation therapy,the therary group peripheral blood T lymphocytes CD3 +,CD4 + cell count was significantly higher than immunomodulation therapy before.The scores of CPIS for the two teams and CD3 +,CD4 + cell count all showed negative correlation (r =-0.689,-0.594,P ＜ 0.01).Conclusion VAP patients in intensive care unit have lower level of T-Lymphocyte Subsets,the immunomodulation therapy can improve immune function;The scores of CPIS and immune function showed negative correlation;Level of immune function can be used for patients to assess the severity of illness,to evaluate the effect of therapy and to prognosis of the important indices. Key words: Ventilator-associated pneumonia; T-Lymphocyte; Subsets Immunoglobulin; Pulmonary infection