2026 年第 10 期 第 21 卷

不同年龄段老年医院获得性肺炎患者25-羟基维生素D水平与辅助性T细胞17/调节性T细胞免疫平衡的相关性研究

Correlation between 25-hydroxyvitamin D level and T helper cell 17/regulatory T cell immune balance in elderly patients with hospital-acquired pneumonia across different age groups

作者：白利芳1王小雨1闫彦2

英文作者：Bai Lifang1 Wang Xiaoyu1 Yan Yan2

单位：1内蒙古自治区人民医院呼吸与危重症医学科，呼和浩特010017;2内蒙古自治区人民医院临床检验医学中心，呼和浩特010017

英文单位：1Department of Respiratory and Critical Care Medicine Inner Mongolia People′s Hospital Hohhot 010017 China; 2Clinical Laboratory Medicine Center Inner Mongolia People′s Hospital Hohhot 010017 China

关键词：老年医院获得性肺炎；不同年龄段；25-羟基维生素D；辅助性T细胞17/调节性T细胞；免疫平衡

英文关键词：Hospital-acquiredpneumonia;Differentagegroups;25-hydroxyvitaminD;Thelpercell17/regulatoryTcell;Immunebalance

• 摘要：

• 目的  探讨不同年龄段老年医院获得性肺炎（HAP）患者外周血25-羟基维生素D［25-(OH)D］水平与辅助性T细胞17/调节性T细胞（Th17/Treg）免疫平衡的关系。方法 选择2023年1月至2025年10月内蒙古自治区人民医院收治的148例老年HAP患者，根据年龄段不同将患者分为3组，低段组（60～70岁）52例、中段组（71～80岁）50例和高段组（＞80岁）46例。根据预后是否良好将患者分为预后不良组（38例）和预后良好组（110例）。对不同年龄段HAP患者的外周血25-(OH)D、Th17、Treg、Th17/Treg及相关因子水平进行比较；对可能影响HAP患者预后的因素进行多因素Logistic回归分析；探究25-(OH)D与年龄对HAP患者预后的协同作用；采用限制性立方样条（RCS）分析25-(OH)D与不同年龄HAP患者预后的关系。结果 低段组患者的25-(OH)D、Treg、白细胞介素10（IL-10）、转化生长因子β1（TGF-β1）水平最高，其次是中段组，高段组上述指标水平最低（均P＜0.05），低段组的Th17、IL-17、IL-6、Th17/Treg水平最低，其次是中段组，高段组最高（均P＜0.05）。预后不良组患者年龄＞80岁占比、有吸烟史占比、Th17、Th17/Treg、IL-17、IL-6水平显著高于预后良好组患者，25-(OH)D、Treg、IL-10、TGF-β1水平显著低于预后良好组患者（均P＜0.05）。多因素Logistic回归分析结果显示，年龄、吸烟史、25-(OH)D、IL-17、IL-6、IL-10、TGF-β1、Th17/Treg是影响HAP患者预后的独立因素（比值比=2.382、2.489、0.465、3.336、2.511、0.694、0.541、1.751，均P＜0.05）。协同作用结果显示25-(OH)D≤50 nmol/L和年龄＞80岁两因素同时存在时HAP患者预后不良发生风险更高。采用RCS分析25-(OH)D与不同年龄HAP患者预后的关系，结果显示，25-(OH)D与预后风险呈非线性负相关，在各年龄组中，25-(OH)D水平越高，预后不良风险越低。结论 25-(OH)D水平与Th17/Treg免疫平衡密切相关，监测不同年龄段HAP患者的25-(OH)D水平，可以有效监测患者免疫状态，同时应更加关注高年龄段患者的病情，降低预后不良的风险。

• Objective To investigate the relationship between peripheral blood 25-hydroxyvitamin D ［25-(OH)D］ level and T helper cell 17/regulatory T cell (Th17/Treg) immune balance in elderly patients with hospital-acquired pneumonia (HAP) in different age groups. Methods A total of 148 elderly HAP patients admitted to Inner Mongolia People′s Hospital from January 2023 to October 2025 were enrolled and divided into three groups by age: young-elderly group (60-70 years, 52 cases), middle-elderly group (71-80 years, 50 cases) and advanced-elderly group (>80 years, 46 cases). Patients were further stratified into poor prognosis group (38 cases) and favorable prognosis group (110 cases) according to clinical outcome. Peripheral blood levels of 25-(OH)D, Th17, Treg, Th17/Treg and related cytokines were compared among HAP patients of different age groups. Multivariate Logistic regression analysis was performed to identify prognostic factors for HAP patients. The synergistic effect of 25-(OH)D and age on the prognosis of HAP patients was explored. Restricted cubic spline (RCS) was adopted to analyze the association between 25-(OH)D and prognosis of HAP patients at different ages. Results The young-elderly group had the highest levels of 25-(OH)D, Treg, interleukin-10 (IL-10) and transforming growth factor-β1 (TGF-β1), followed by the middle-elderly group, while the advanced-elderly group showed the lowest levels of these indicators (all P＜0.05). The young-elderly group presented the lowest levels of Th17, IL-17, IL-6 and Th17/Treg, followed by the middle-elderly group, and the advanced-elderly group had the highest values (all P＜0.05). The proportions of patients aged＞80 years and patients with smoking history, as well as levels of Th17, Th17/Treg, IL-17 and IL-6 in the poor prognosis group were significantly higher than those in the favorable prognosis group, whereas 25-(OH)D, Treg, IL-10 and TGF-β1 levels were markedly lower (all P＜0.05). Multivariate Logistic regression demonstrated that age, smoking history, 25-(OH)D, IL-17, IL-6, IL-10, TGF-β1 and Th17/Treg were independent prognostic factors for HAP patients (odds ratio=2.382, 2.489, 0.465, 3.336, 2.511, 0.694, 0.541, 1.751, all P＜0.05). Synergy analysis revealed that the coexistence of 25-(OH)D ≤50 nmol/L and age＞80 years conferred a higher risk of poor prognosis in HAP patients. RCS analysis indicated a nonlinear negative correlation between 25-(OH)D and prognostic risk; within each age subgroup, higher 25-(OH)D levels were associated with lower risk of poor prognosis. Conclusion 25-(OH)D level is closely correlated with Th17/Treg immune balance. Monitoring 25-(OH)D levels in HAP patients of different age groups enables effective evaluation of immune status. Special attention should be paid to advanced-elderly patients to reduce the risk of adverse prognosis.