96例噬血细胞综合征儿童外周血CD4^+T细胞亚群、淋巴细胞亚群分析

Analysis of peripheral blood CD4^+T lymphocyte subsets and lymphocyte subsets in 96 children with hemophagocytic syndrome

目的:探究噬血细胞综合征(hemophagocytic syndrome,HPS)患儿外周血CD4+T细胞亚群及淋巴细胞亚群的变化及意义。方法:选取2010年2月至2017年1月郑州大学附属儿童医院血液肿瘤科收治的96例HPS患儿为研究对象(HPS组),入院后按照相关推荐方案实施化学治疗(简称化疗),根据治疗效果将患儿分为预后良好组与预后不良组。另选40名同期入院体检的健康儿童作为对照组。HPS患儿于就诊第2天、治疗结束后,对照组于体检当天清晨采集空腹静脉血,采用流式细胞仪测定外周血CD4^+T细胞亚群Th1,Th2,Th17,Treg,淋巴细胞亚群CD3^+,CD4^+,CD8^+,CD19^+。结果:与对照组相比,HPS组Th2,Th17,Th17/Treg比值均明显升高,Th1/Th2比值、Treg明显降低;且CD3^+,CD8+明显升高,CD4^+,CD4^+/CD8^+比值明显降低,差异均有统计学意义(P<0.05);CD19^+水平差异无统计学意义(P>0.05)。HPS组经3个阶段的化疗后,26例(27.08%)有效、36例(37.50%)疾病缓解、7例(7.29%)疾病活动、3例(3.13%)疾病复发、24例(25.00%)死亡。与预后良好组患儿相比,预后不良组患儿Th2,Th17,Th17/Treg比值均明显升高,Th1/Th2比值、Treg明显降低;且CD3^+,CD8^+明显升高,CD4^+,CD4^+/CD8^+比值明显降低,差异均有统计学意义(P<0.05);CD19^+差异无统计学意义(P>0.05)。结论:HPS儿童存在外周血CD4^+T细胞亚群及T细胞亚群异常,可用于评估患儿免疫功能损害及判断其预后。

Objective:To analyze the changes and significance of CD4^+T lymphocyte subsets and lymphocyte subsets in peripheral blood of 96 children with hemophagocytic syndrome(HPS).Methods:A total of 96 children with HPS who were admitted to the department of hematology and oncology of the hospital from February 2010 to January 2017 were selected as the subjects(HPS group).They were treated with chemotherapy after admission according to the relevant recommended regimen.According to the therapeutic effect,the children were divided into a good prognosis group and a poor prognosis group;40 healthy children admitted to the hospital at the same time were selected as a control group.The fasting venous blood of children with HPS was collected at the 2nd day after the admission and after the end of treatment,while the fasting venous blood of the control group was collected in the morning on the day of physical examination.The peripheral blood CD4^+T cell subsets Th1,Th2,Th17 and Treg,lymphocyte subsets CD3^+,CD4^+,CD8^+ and CD19^+ were determined by flow cytometry.Results:The Th2,Th17 and Th17/Treg,CD3^+ and CD8^+ were significantly higher,while Th1/Th2 and Treg,CD4^+ and CD4^+/CD8^+ were significantly lower in HPS group than in the control group(P<0.05),there was no significant difference in CD19+between the two groups(P>0.05).After three stages of chemotherapy,26 cases(27.08%)were effectively treated,36 cases(37.50%)were relieved,7 cases(7.29%)had disease activity,3 cases(3.13%)had recurrence,and 24 cases(25.00%)died.The Th2,Th17 and Th17/Treg,CD3^+ and CD8^+ were significantly higher,while Th1/Th2 and Treg,CD4^+ and CD4^+/CD8^+ were significantly lower in the poor prognosis group than in the good prognosis group(P<0.05),there was no significant difference in CD19^+ between the two groups(P>0.05).Conclusion:Children with HPS have abnormal CD4^+T cells subsets and T cell subsets in peripheral blood,which can be used to evaluate the damage of immune function and prognosis in children.