北京市重症急性呼吸综合征患者的临床免疫学特点

Immunological characteristics of 1291 cases of severe acute respiratory syndrome in Beijing

目的 探索北京市所有重症急性呼吸综合征 (SARS)患者的临床免疫学特点及其规律。方法 对 2 0 0 3年 3～ 7月期间在北京非典型肺炎定点医院住院的所有SARS患者病历进行完整录入、数据处理、回顾性统计分析。结果 2 0 0 3年 3～ 7月期间资料完整的确诊SARS患者 12 91例 ,其白细胞总数、淋巴细胞、CD3 、CD4、CD8淋巴细胞亚群绝对值均在发病早期同时下降 ,总阳性率分别为5 6 91%、88 2 6 %、4 7 96 %、4 5 5 6 %及 4 1 10 % ;其CD3 、CD4、CD8在前 3天中位数分别为 4 2 5× 10 6/L、2 2 3× 10 6/L、170× 10 6/L ,达病程的最低值 ;第 2周分别为 5 36× 10 6/L、2 6 7× 10 6/L、2 2 4× 10 6/L ,至第 4周恢复正常 (P <0 0 5 ) ;其数值出现随病程发展逐渐升高的正相关趋势。将连续 4周检测的同一组患者 ,分别与相邻时间段的同一组患者和所有非同组患者的各免疫学指标进行比较分析 ,3组中CD3 、CD4、CD8表达仍然是第 1～ 3天最低 ,除连续检测组第 3周CD3 的中位数 (95 4× 10 6/L)偏高外 ,其他 3组间差异无显著性 (P <0 0 5 ) ,各数据与病程呈平行升高趋势。C反应蛋白早期升高 ,血沉 ,补体C3 、C4均在正常范围内。结论 SARS患者的发病早期白细胞、淋巴细胞、淋巴细胞亚群CD3 、CD4、CD8均同时明显?

Objective To investigate the immunological characteristics of the cases of severe acute respiratory syndrome (SARS) in Beijing City. Methods Clinical data of 1291 patients with SARS from March to July 2003 in Beijing City were retrospectively analyzed. Results In patients with SARS,the absolute numbers of white blood cells,lymphocytes and CD_3,CD_4 and CD_8 lymphocyte subsets decreased during the early period of the disease,being manifested in 56.91%,88.26%,47.96%,45.56% and 41.10% of the patients,respectively. During the first 3 days the median numbers of CD_3,CD_4 and CD_8 were 425×10 6/L ,223×10 6/L ,170×10 6/L,respectively,being the lowest values in the course of the disease. During the second week the corresponding numbers were 536×10 6/L,267×10 6/L,224×10 6/L,respectively; they returned to normal by the fourth week (P<0.05),showing a trend of gradual increase during the disease progression. Comparison of different time points of the same cases also showed that CD_3,CD_4 and CD_8 were lowest in the first 1-3 days. The median number of CD_3 was higher (954×10 6/L) during week 3,and there was no significant difference among other 3 weeks (P>0.05). In the early period of the disease the CRP increased but ESR,C_3 and C_4 were still in normal ranges. Conclusions In the early period of SARS,the WBC,lymphocytes,CD_3,CD_4 and CD_8 lymphocyte subsets decreased remarkably,and they tended to increase as the disease progressed. Simultaneous decreases in CD_3,CD_4 and CD_8 during the first week is a characteristic immunological change,which may facilitate the early diagnosis of SARS.