Objective To investigate the pleural effusion lymphocyte subsets in patients with pneumonia complicated with pleural effusion and its relationship with the occurrence of critical illness. MethodsPatients with pneumonia complicated with pleural effusion (246 cases) admitted to our hospital from January 2020 to June 2022 were selected as the research subjects. According to the severity of pneumonia, they were divided into a critical group (n=150) and a non-critical group (n=96). After 1:1 matching by propensity score matching method, there were 60 cases in each group. The general data of the two groups were compared. CD3+, CD4+, CD8+, CD4+/CD8+ ratio were detected by flow cytometry. Multivariate logistic regression was used to analyze the risk factors of critical pneumonia, and a nomogram prediction model was constructed and evaluated. The relationship between PSI score and lymphocyte subsets in pleural effusion was analyzed by local weighted regression scatter smoothing (LOWESS). Results After matching, the differences between the two groups of patients in the course of disease, heat peak, heat course, atelectasis, peripheral white blood cell count (WBC), C-reactive protein (CRP), D-dimer (D-D), procalcitonin (PCT) and hemoglobin were statistically significant (P<0.05). Compared with the non-critical group, the proportion of CD3+, CD4+, CD4+/CD8+ cells in critical group was lower (P<0.05), and the proportion of CD8+ cells was higher (P<0.05). Combined atelectasis, increased course of disease, fever peak and fever course, increased WBC, CRP, D-D, CD8+ and PCT levels, and decreased CD3+, CD4+, CD4+/CD8+ and Hb levels were independent risk factors for the occurrence of critical pneumonia (P<0.05). The nomogram prediction model based on independent influencing factors had high discrimination, accuracy and clinical applicability. There was a certain nonlinear relationship between pneomonia severity index and CD3+, CD4+, CD8+ and CD4+/CD8+. Conclusions Lymphocyte subsets in pleural effusion are closely related to the severity of pneumonia complicated with pleural effusion. If CD3+, CD4+, CD8+ and CD4+/CD8+ are abnormal, attention should be paid to the occurrence of severe pneumonia.
Objective To observe the level of vascular endothelium growth factor A( VEGF-A) in exhaled breath condensate ( EBC) of patients with acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) , and investigate its clinical significance. Methods EBC of 23 patients with ALI/ARDS by mechanical ventilation in intensive care unit ( ICU) were collected with improved EcoScreen condenser. EBC of 17 normal control subjects were collected with EcoScreen condensor. The level of VEGF-A was measured by ELISA in EBC and serum. The levels of VEGF-A in EBC of patients with different grades of lung injuries were compared, and the correlation was analyzed between the level of VEGF-A and clinical indicators. Results The level of VEGF-A in EBC was lower in the patients with ALI/ARDS than that of control subjects [ ( 49. 88 ±6. 32) ng/L vs. ( 56. 50 ±6. 323) ng/L, P lt;0. 01] , the level of VEGF-A was higher in the ALI patients than that of ARDS patients [ ( 53. 56 ±5. 56) ng/L vs. ( 45. 86 ±4. 45) ng/L, P lt;0. 01] ,and higher in the survival patients than that of the died patients [ ( 51. 92 ±6. 28) ng/L vs. ( 46. 05 ± 4. 58) ng/L, P lt;0. 05] . The level of VEGF-A in EBC was negatively correlated with lung injury score and A-aDO2 /PaO2 ( r = - 0. 426 and - 0. 510, respectively, P lt;0. 05) , and positively correlated with PaO2 /FiO2 and PaO2 ( r =0. 626 and 0. 655, respectively, P lt; 0. 05) . The level of VEGF-A in serum was not different between the ALI/ARDS patients and the control subjects, between the ALI and ARDS patients, or between the survival and the died patients ( all P gt;0. 05) . The level of VEGF-A in serumhad no correlation with lung injury score, A-aDO2 /PaO2 , PaO2 /FiO2 , or PaO2 ( all P gt;0. 05) . Conclusion The changes of VEGF-A in EBC of patients with ALI/ARDSmay serve as an indicator for severity and prognosis evaluation.
Objective To investigate the concentration of 8-isoprostaglandin ( 8-iso-PG) in exhaled breath condensate ( EBC) of patients with acute lung injury/acute respiratory distress syndrome ( ALI/ ARDS) , and evaluate its clinical significance. Methods Thirty-one ALI/ARDS patients who received mechanical ventilation were recruited as an experimental group, and EBC was collected with improved EcoScreen condenser, while thirty normal subjects were recruited as a control group. The 8-iso-PG level in EBC was analyzed by ELISA. The ALI/ARDS patients were subdivided into a continuous ALI group ( n=10) , a continuous ARDS group ( n=9) , a worsening group ( n=6) , and a remission group ( n=6) by state of illness on 1st day and 5th day. The 8-iso-PG level in EBC of the ALI/ARDS patients with different severity and different prognosis were compared, and the correlation were analyzed between the 8-iso-PG level and clinical indicators. Results The 8-iso-PG levels in EBC of the ALI/ARDS patients on 1st day and 5th day were higher than those in the control subjects respectively [ ( 45.53 ±14.37) ng/L and ( 45.31 ±12.42) ng/L vs. ( 19.47 ±4.06) ng/L, Plt;0.001] . The 8-iso-PG level was higher in the worsening group than the remission group, higher in the continuous ARDS group than the continuous ALI group, and higher in the nonsurvival group than the survival group ( Plt;0.05) . The 8-iso-PG level in EBC was positively correlated with white blood cell count in peripheral blood, lung injury score, X-ray score, AaDO2 /PaO2 , AaDO2 , VT , VE and MEWS score, and negatively correlated with PaO2 /PAO2 and PaO2 /FiO2 . Conclusion The 8-iso-PG level in EBC of ALI/ARDS patients has reference value for judging severity and prognosis of ALI/ARDS.