肾综合征出血热患者淋巴细胞亚群的动态变化

The dynamics of T lymphocyte subsets in hemorrhagic fever with renal syndrome

目的研究肾综合征出血热（HFRS）患者病程不同阶段以及不同病情T、B、NK淋巴细胞亚群的变化，进一步揭示本病的发病机制。方法 入选22例确诊HFRS患者，其中轻型9例，中型13例，使用流式细胞技术检测发病1、4、12周时淋巴细胞亚群。56例健康献血员作为正常对照组。将疾病不同阶段与对照组及轻、中型患者之间进行比较分析。结果在本研究观察的12周中，患者B细胞计数与对照组比较差异无统计学意义；而NK细胞计数起病1周时有显著下降（P〈0．01），在4周时迅速恢复。本研究中HFRS患者CD4^＋T淋巴细胞计数与对照组比较差异无统计学意义，但在发病1、4周时记忆表型的CD4^＋CD45RA—T淋巴细胞比例增高（P〈0．01），分别达到（54．1±17．5）％、（59．9±10．1）％，在12周时恢复正常。CD4^＋CD28^＋T淋巴细胞功能亚群无显著变化。CD8^＋T淋巴细胞计数在发病1、4周时有明显增高，12周恢复正常。CD8CD28^-T淋巴细胞计数有显著增高（P〈0．05），且在轻型患者中这种变化更迅速、显著。与正常对照组相比，CD38^＋或HLA—DR^＋的CD8^＋T淋巴细胞激活亚群在发病1、4周时也有明显增高（P〈0．01）。结论细胞免疫与HFRS有密切的关系，早期细胞毒效应T细胞及时有效的应答能清除病毒，减轻病情。

Objectives To investigate the T cell subsets changes in hemorrhagic fever with renal syndrome （HFRS） patients. Methods 22 HFRS patients who were diagnosed in Qin Huang Dao Third Hospital from April 2005 to July 2005 were enrolled in this study and divided into two groups according to clinical manifestations. T cell subsets of the 22 patients were monitored at week 1, 4 and 12. Another 56 subjects were enrolled as healthy controls. Results B cell count was normal during the 12 weeks in all the subjects. NK cell decreased significantly at week 1, and recovered at week 4 rapidly. CD4＋ T cell count was normal throughout the course of the disease, but the percentage of memory phenotypy increased at week 1 and 4, reaching（6d. 1±17. 5） % and （59. 9±10. 1 ） %, but recovered at week 12. CD4^＋ CD28T cells were normal throughout the entire study. CDs T cell count increased dramatically at week 1 and 4, but finally recovered at week 12. The count of CD8^＋CD28T cells increased significantly at week 1 in low-grade goup, but in median-grade group, this increase lagged to week 4 and was not as significant as in low-grade group. The percentage of CD3s or HLA-DR^＋ subsets of CDs T cell increased at week 1, 4. Conclusion The results confirmed the relationship between HFRS progression and cellular immunity. It revealed that, at the early stage of HFRS, rapid and effective cytotoxicity T lymphocyte response may contribute to clear Hantavirus away and improve HFRS symptom.