60歳以上の高齢者市中肺炎の治癒期間とCD4リンパ球数の関係

The Recovery Period from Pneumonia Correlated with the CD4 Lymphocyte Count or Other General Blood Test Parameters in Elderly Patients

要旨　【目的】60歳以上の高齢者において，肺炎治癒期間の差にCD4リンパ球数などが影響しているかどうかを検討する．【方法】当院に入院した60歳以上の市中肺炎患者104人を対象に，入院時の採血項目と肺炎治癒期間との関係を検討した．【結果】死亡群のCD4リンパ球数(208±51/μl)は治癒群(520±34/μl)と健常人(812±67/μl)と比較して有意に低値を示していた(p＜0.01)．一方，CD4リンパ球数と治癒期間との関係はなかった(p＝0.09)．死亡群の血清アルブミン値(2.65±0.11g/dl)は治癒群(3.30±0.06g/dl)と健常人(3.98±0.04g/dl)を比較し有意に低値を示していた(p＜0.01)．血清アルブミン値と肺炎治癒期間には相関を認めた(p＜0.01)．【結語】CD4リンパ球数が低値の場合，肺炎は重症化しやすく，血清アルブミン値が低値の場合は治癒期間の遷延が認められた．

【Objective】This study aimed to determine whether the recovery period from pneumonia might be correlated with the CD4 lymphocyte count or other general blood test parameters in patients aged 60 years or older.【Methods】Routine blood counts with additional test parameters, including the CD4 lymphocyte count, were performed on admission or immediately after in 104 patients aged 60 years or older who were hospitalized for treatment of community-acquired pneumonia from October 2005, in order to examine whether the duration of treatment with antibiotics(considered to represent the recovery period from pneumonia)was correlated with the CD4 lymphocyte count or other general blood test parameters.【Results】The CD4 lymphocyte counts were significantly reduced in patients who died of pneumonia(non-survivor group, n＝10)as compared with those among the patients who recovered from the pneumonia(recovery group, n＝94)and normal individuals(normal group, n＝68)(208±51/μl vs. 520±34/μl and 812±67/μl, respectively;p＜0.01). However, there was no correlation between the CD4 lymphocyte count and the recovery period from pneumonia in the recovery group(p＝0.09, r＝0.16). The serum Alb level was significantly reduced in the non-survivor group as compared with the values in the recovery and normal groups(2.65±0.11g/dl vs. 3.30±0.06g/dl and 3.98±0.04g/dl, respectively;p＜0.01). The serum Alb was correlated with the recovery period from pneumonia in the recovery group(p＜0.01).【Conclusions】Pneumonia is more likely to become severe in patients with lower CD4 lymphocyte counts, and may also follow a protracted course and become severe in patients with low serum Alb levels.