Value of CD4+ effector memory T cells and interleukin-6 combined with hypersensitive C-reactive protein in the diagnosis of pulmonary infection in patients with acute ischemic stroke

doi:10.3969/j.issn.1672-6731.2021.04.013

Abstract

Abstract:

Objective To explore the expression of CD4⁺ effector memory T cells (CD4⁺TEM) in peripheral blood of acute ischemic stroke patients with pulmonary infection, and to analyze the value of CD4⁺TEM combined with interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) in the diagnosis of pulmonary infection in patients with acute ischemic stroke. Methods Totally 54 confirmed acute ischemic stroke patients with pulmonary infection who were treated in the Department of Neurology at The Affiliated Hospital of Xuzhou Medical University from June 2018 to December 2019 were chosen as the infection group, meanwhile, 55 acute ischemic stroke patients without pulmonary infection were assigned as the control group. The clinical characters and the expression levels of CD4⁺TEM cells were compared in the 2 groups. Univariate and multivariate Logistic regression analysis were used to screen the risk factors of pulmonary infection in patients with acute ischemic stroke, and receiver operating characteristic (ROC) curve was further conducted to evaluate the diagnostic value of the percentage of CD4⁺TEM, IL-6, hs-CRP and combined detection in pulmonary infection patients with acute ischemic stroke. Results Multivariate Logistic regression analysis showed that the increased percentage of CD4⁺TEM cells (OR=1.153, 95%CI: 1.069-1.244; P=0.000), IL-6 (OR=1.351, 95%CI: 1.046-1.747; P=0.021) and hs-CRP (OR=1.087, 95%CI: 1.008-1.172; P=0.021) were important risk factors for pulmonary infection with acute ischemic stroke. When the percentage of CD4⁺TEM cells, IL-6 and hs-CRP were used as predictors of pulmonary infection with acute ischemic stroke alone, the area under the ROC curve were 0.906 (95%CI: 0.850-0.961), 0.799 (95%CI: 0.714-0.885) and 0.831 (95%CI: 0.754-0.908) respectively. When the percentage of CD4⁺TEM cells were combined with IL-6 and hs-CRP, the area under the curve increased to 0.943 (95%CI: 0.904-0.982). Conclusions The percentage of CD4⁺TEM cells combined with IL-6 and hs-CRP has better diagnostic value for pulmonary infection with acute ischemic stroke, and can be used as biomarkers for early prediction of pulmonary infection with acute ischemic stroke.

Key words: Stroke, Brain ischemic, Lung, Infection, CD4-positive T-lymphocytes, Interleukin-6, C-reactive protein

摘要：

目的探讨CD4⁺效应型记忆T细胞（CD4⁺TEM）在急性缺血性卒中肺感染患者外周血表达变化，分析其与白细胞介素-6（IL-6）和超敏C-反应蛋白（hs-CRP）联合检测对急性缺血性卒中肺感染的诊断价值。方法选择2018年6月至2019年12月确诊的54例急性缺血性卒中并肺感染患者为研究对象，并以同期住院的55例未合并肺感染的急性缺血性卒中患者作为对照，比较两组发病特点，以及外周血CD4⁺TEM细胞表达变化；单因素和多因素Logistic回归分析筛查急性缺血性卒中肺感染危险因素，结合受试者工作特征曲线（ROC曲线）评价CD4⁺TEM细胞百分率、IL-6和hs-CRP单独检测，以及联合应用的预测价值。结果经多因素Logistic回归分析，CD4⁺TEM细胞百分率（OR=1.153，95% CI：1.069~1.244；P=0.000）、IL-6（OR=1.351，95% CI：1.046~1.747；P=0.021）和hs-CRP（OR=1.087，95% CI：1.008~1.172；P=0.021）水平升高是急性缺血性卒中肺感染的重要危险因素。经ROC曲线分析，CD4⁺TEM细胞百分率、IL-6和hs-CRP单独作为肺感染预测指标时，其曲线下面积分别为0.906（95% CI：0.850~0.961）、0.799（95% CI：0.714~0.885）和0.831（95% CI：0.754~0.908）；三者联合应用则曲线下面积增至0.943（95% CI：0.904~0.982）。结论 CD4⁺TEM细胞百分率与外周血IL-6和hs-CRP联合应用对急性缺血性卒中肺感染具有良好的诊断价值，可作为急性缺血性卒中发病早期预测合并肺感染的生物学标志物。

关键词: 卒中, 脑缺血, 肺, 感染, CD4阳性T淋巴细胞, 白细胞介素6, C反应蛋白质

HUANG Xiao-yu, LI Feng-zhan, LIU Tan, YANG Ting-ting, FU Lin-lin, ZHANG Yong. Value of CD4⁺ effector memory T cells and interleukin-6 combined with hypersensitive C-reactive protein in the diagnosis of pulmonary infection in patients with acute ischemic stroke[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(4): 310-316.

黄小雨, 李凤展, 刘坛, 杨婷婷, 付琳琳, 张勇. CD4⁺效应型记忆T细胞与白细胞介素-6联合超敏C-反应蛋白对急性缺血性卒中合并肺感染的诊断价值[J]. 中国现代神经疾病杂志, 2021, 21(4): 310-316.

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