通讯作者: 张恒瑞, 18351973982@163.com

DOI：10.12201/bmr.202606.00062

Research on the prognosis of pneumonia caused by multi-drug resistant bacteria and its correlation with cellular immunity and analysis of risk factors

• 摘要：目的 探讨多重耐药菌(multi drug resistant, MDR)感染肺炎患者外周血T淋巴细胞亚群计数与其预后的相关研究及其危险因素分析。方法 回顾性分析2022年1月~2025年6月南京医科大学第二附属医院呼吸与危重症医学科诊治的多重耐药菌感染肺炎患者86 例，根据30天内死亡与存活情况分为死亡组与存活组。比较两组患者一般资料、T淋巴细胞亚群计数、临床指标及急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation Ⅱ, APACHE Ⅱ)之间的差异。多因素Logistic回归分析多重耐药菌感染肺炎患者死亡的危险因素。采用受试者工作特征(receiver operating characteristic curve, ROC)曲线计算曲线下面积（Area under the curve, AUC）。P＜0.05为差异有统计学意义。 结果 死亡组CD4+、CD8+及CD3+T淋巴细胞计数明显低于存活组（P＜0.05）；多因素Logistic回归分析结果提示APACHEⅡ评分和CD4+T淋巴细胞计数为多重耐药菌感染性肺炎患者死亡的独立危险因素；CD4+T淋巴细胞计数、APACHE Ⅱ评分、CD4+T淋巴细胞计数联合APACHE Ⅱ评分预测多重耐药菌感染性肺炎短期死亡ROC曲线下面积（AUC），分别为0.714、0.913、0.932，最佳截断值分别为325.00∕μl 、17.5分、0.289。结论 多重耐药菌感染肺炎患者CD4+T淋巴细胞计数低于325.00∕μl、APACHE Ⅱ评分高于17.5分时死亡风险较大，入院时检测外周血T淋巴细胞计数联合APACHE Ⅱ评分能够提高对多重耐药菌感染性肺炎病情及预后的预测价值。

  关键词： 多重耐药感染性肺炎； T淋巴细胞亚群计数； APACHE Ⅱ评分；危险因素分析; ; ; 

   

  Abstract: Objective To investigate the correlation between peripheral blood T lymphocyte subset counts and the prognosis of patients with multi-drug resistant (MDR) bacterial pneumonia and to analyze the risk factors for mortality. Methods A retrospective analysis was conducted on 86 patients with MDR bacterial pneumonia diagnosed and treated in the Department of Respiratory and Critical Care Medicine at the Second Affiliated Hospital of Nanjing Medical University from January 2022 to June 2025. Based on their 30-day survival status, patients were divided into a death group and a survival group. The general characteristics, T lymphocyte subset counts, clinical indicators, and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were compared between the two groups. Multivariate logistic regression analysis was used to identify risk factors for mortality in patients with MDR pneumonia. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC). A P-value < 0.05 was considered statistically significant. Results The counts of CD4+, CD8+, and CD3+ T lymphocytes in the death group were significantly lower than those in the survival group (P < 0.05). The APACHE II score was significantly higher in the death group than in the survival group. Multivariate logistic regression analysis indicated that both a high APACHE II score and a low CD4+ T lymphocyte count were independent risk factors for mortality in patients with MDR pneumonia. The areas under the ROC curve (AUC) for predicting short-term mortality using the CD4+ T lymphocyte count, APACHE II score, and their combination were 0.714, 0.913, and 0.932, respectively. The optimal cut-off values were 325.00/μL, 17.5 points, and 0.289, respectively. Conclusion Patients with MDR pneumonia face a significantly higher risk of mortality when their CD4+ T lymphocyte count falls below 325.00/μL or their APACHE II score exceeds 17.5 points. The detection of peripheral blood T lymphocyte count at admission combined with the APACHE Ⅱ score can improve the predictive value for the condition and prognosis of multidrug-resistant bacterial infectious pneumonia.

  Key words: Multi-drug resistant bacterial pneumonia; T lymphocyte subset count; APACHE Ⅱ score; Risk factor analysis

  提交时间：2026-06-20

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 施明杰, 叶洪舟, 袁琛. 大环内酯类耐药肺炎支原体肺炎患儿发展为重症肺炎的危险因素分析及预测模型构建. 2024. doi: 10.12201/bmr.202409.00021

  时小淋, 汤冬静, 吴美慧. 儿童肺炎支原体支气管肺炎和大叶性肺炎的相关危险因素分析. 2025. doi: 10.12201/bmr.202507.00035

  刘瑞霞, 杨东, 侯瑞军, 邬海燕. 流行性感冒致肝损害的危险因素分析及其与血清NLR、SII水平的相关性. 2026. doi: 10.12201/bmr.202602.00028

  周妮, 谷强. 儿童大叶性肺炎病程的危险因素及风险预测. 2025. doi: 10.12201/bmr.202504.00059

  徐玲凤, 马玥, 陈莉, 徐一帆, 陈玲玲, 黄婷. 424例肝移植患者术后医院感染的危险因素、感染特征及病原菌分析. 2026. doi: 10.12201/bmr.202602.00010

  李霖, 韦维, 刘文辉. 老年髋部骨折术后肺部感染相关危险因素分析. 2026. doi: 10.12201/bmr.202601.00037

  冀鹏磊, 髙崴崴, 李佳霖, 刘待见, 王昱林. 免疫炎症相关指数与重症肺炎转归相关性分析. 2024. doi: 10.12201/bmr.202409.00062

  马亚林, 陈晓林, 李武殷, 冯妍妍, 韩萌, 陆媛, 杨启凡, 李睿. 儿童血液病医院感染临床特征及危险因素分析. 2026. doi: 10.12201/bmr.202604.00126

  项云, 苏元晖, 谢春红, 张惠菊, 聂艳琴, 陈兴, 黄连江. 黏液型与非黏液型肺炎链球菌感染分布特征及耐药性分析. 2025. doi: 10.12201/bmr.202504.00062

  p>何海玲, 陆建良, 冯媛, 卢艳玲. 儿童重症肺炎支原体肺炎的临床特点分析. 2025. doi: 10.12201/bmr.202505.00038

• 序号	提交日期	编号	操作
  1	2026-02-27	10.12201/bmr.202606.00062V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论