外周血Th17和Th22细胞在呼吸机相关性肺炎患者中的水平变化及临床意义

目的 观察外周血Th17和Th22细胞在呼吸机相关性肺炎（VAP）中的水平变化及临床意义。方法 选取2014年01月至2019年01月于本院行机械辅助通气治疗的患者810例作为研究对象。采用流式细胞术检测患者外周血Th17和Th22细胞水平；酶联免疫吸附法检测相关炎性细胞因子（IL-17、IL-22）水平，绘制受试者工作曲线（ROC曲线），评价外周血Th17和Th22细胞水平对VAP患者预后的曲线下面积（AUC）和最佳截断值。结果 VAP组患者外周血Th17、Th22细胞水平及IL-17和IL-22水平高于非VAP组（t=66.050，P<0.001；U=54.630，P<0.001；t=27.530，P<0.001；t=28.500，P<0.001）；高危组VAP患者中上述指标水平最高，中危组次之，低危组最低，差异比较具有统计学意义（F=39.440，P<0.001；F=71.400，P<0.001；F=50.640，P<0.001；F=94.510，P<0.001）。死亡组患者上述指标水平高于存活组（t=3.098，P=0.002；t=4.322，P<0.001；t=4.825，P<0.001；t=4.122，P<0.001）。VAP患者外周血Th22细胞与Th17细胞、IL-22及APACHEⅡ评分呈正相关（r1=0.8200，P1<0.001；r2=0.895，P2<0.001；r3=0.752，P3<0.001）；同时外周血Th17细胞与IL-17、APACHEⅡ评分呈正相关（r1=0.832，P1<0.001；r2=0.710，P2<0.001）。ROC曲线分析显示，外周血Th22细胞曲线下面积为0.874 (0.813~0.935)，其最佳工作点为7.92，此时评估VAP患者预后不佳的敏感性和特异性分别为79.49%和78.93%，优于外周血Th17细胞，但差异无统计学意义（Z=0.810，P=0.310）。 结论 外周血Th17和Th22细胞水平在VAP患者中显著升高，对于VAP患者预后的评估，具有一定的临床应用价值。

The levels and clinical significance of Th17 and Th22 cells in peripheral blood in patients with ventilator-associated pneumonia

Objective To observe the levels and clinical significance of Th17 and Th22 cells in patients with ventilator-associated pneumonia(VAP). Methods A total of 810 patients who underwent mechanically assisted ventilation therapy from January 2014 to January 2019 in Jiangbei District People’s Hospital in Chongqing were selected as the research object. The levels of Th17 and Th22 cells in peripheral blood of patients were detected by flow cytometry. The levels of related inflammatory cytokines(IL-17, IL-22) were detected by enzyme-linked immunosorbent assay(ELISA), and the receiver operating characteristic curve(ROC) was drawn to evaluate the area under the curve(AUC) and the optimal cutoff value of Th17 and Th22 cell levels in the peripheral blood for the prognosis of VAP. Results The levels of Th17 and Th22 cells, IL-17 and IL-22 in peripheral blood in patients with VAP were higher than those in non-VAP group(t=66.050, P<0.001; U=54.630, P<0.001; t=27.530, P<0.001; t=28.500, P<0.001). The levels of the above indicators in the high-risk group were highest, the middle-risk group were the second, and the low-risk group were the lowest(F=39.440, P<0.001; F=71.400, P<0.001; F=50.640, P<0.001; F=94.510, P<0.001). The levels of the above indicators in the death group were higher than those in the survival group(t=3.098, P=0.002; t=4.322, P<0.001; t=4.825, P<0.001; t=4.122, P<0.001). There was a positive correlation between Th22 cells and Th17 cells, IL-22 and APACHE II scores in patients with VAP(r1=0.8200, P1<0.001; r2=0.895, P2<0.001; r3=0.752, P3<0.001). Meanwhile, there was a positive correlation between Th17 cells and IL-17 and APACHE II scores in patients with VAP(r1=0.832, P1<0.001; r2=0.710, P2<0.001). ROC curves analysis showed that the area under curve of Th22 in peripheral blood was 0.874(95%CI: 0.813-0.935), and optimal operating point(OOP) was 7.92, which had 79.49% sensitivity and 78.93% specificity in predicting the prognosis of VAP, which were better than those of Th17 cells. However, there was no significant difference between the two groups(Ζ=0.810, P=0.310). Conclusion The levels of Th17 and Th22 cells in peripheral blood is closely related to the occurrence and development of VAP, which has certain clinical application value for predicting the severity of VAP.