慢性活动性EB病毒感染外周血淋巴细胞免疫亚群变化特征的研究

Characteristics of peripheral blood lymphocyte immune subsets in patients with chronic active Epstein-Barr virus infection

目的研究慢性活动性EB病毒感染（CAEBV）宿主细胞免疫功能的变化。方法应用流式细胞仪检测2004年3月至2008年4月住院的CAEBV患儿、急性EBV感染（acute EBV infection，AEBV）患儿以及正常儿童外周血淋巴细胞免疫亚群。结果CAEBV组外周血白细胞[3325×10^6／L，中位数（下同）]、淋巴细胞（1078×10^6／L）、NK细胞（68×10^6／L）、B细胞（84×10^6 ／L）、总T细胞（684×10^6/L）、CD4^＋ T细胞（406×10^6 ／L）和CD8^＋ T细胞（295×10^＋／L）计数均高于AEBV组（P〈0．05）。CAEBV组CD4^＋功能亚群的比例（94．5％）低于正常组（98．7％）（P〈0．05），但高于AEBV组（74．0％）（P〈0．05）；而CD8^＋功能亚群的比例（40．7％）与正常组（48．3％）比较差异无统计学意义，但高于AEBV组（21．0％）（P〈0．05）。CAEBV组的调节亚群比例（5．0％）虽高于正常组（4．6％）（P〈0．05），但低于AEBV组（5．8％）（P〈0．05）。CAEBV组初始T细胞比例（32．3％／37．5％）低于正常组（58．3％／56．6％）（P〈0．05），其效应记忆T细胞的比例（23．9％／15．1％）低于较AEBV组（36．5％／69．8％）（P〈0．05），而CD8^＋假初始T细胞（17．5％）的比例高于其他两组（12．0％和9．2％）（P〈0．05）。CAEBV组CD8’激活亚群（84．4％／34．0％）高于正常组（44．1％／16．7％）（P〈0．05），但低于AEBV组（96．0％／95．0％）（P〈0．05）。结论CAEBV患儿体内存在淋巴细胞亚群失衡和细胞免疫功能紊乱，可能与CAEBV的慢性活动性有关。检测外周血淋巴细胞亚群有助于CAEBV的诊断和鉴别诊断。

Objective To study the characteristics of the peripheral blood lymphocyte subsets in pediatric patients with chronic active EBV （CAEBV） infection. Method Flow cytometry was used to detect the peripheral blood NK, B, T lymphocyte subsets and the functional, regulatory, naive, memory and activatory subsets of T lymphocytes in 10 pediatric patients with CAEBV infection, 13 pediatric patients with acute Epstein-Barr virus infection （AEBV） and 12 healthy children in our hospital between March 2004 and April 2008. Result Compared with AEBV group, the number of white blood cells [ 3325 ×10^6/L（ median, just the same as the following）] .lymphocytes （1078 ×10^6/L） , NK cells（68 ×10^6/L）, B cells（84 ×10^6/ L）, total Y cells（684×10^6/L）, CIM ＋ T cells（406 ×10^6/L） and CD^8＋ T cells（295×10^6/L） in CAEBV patients were lower （P 〈 0. 05 ）. The functional subset of the CD^4 ＋ T cells in CAEBV group （94. 5% ）was lower than those of the healthy control group（ 98.7% ） （ P 〈 0. 05 ）, but was still higher than those of AEBV group（74. 0% ） （P 〈0. 05）. While the functional subset of the CD8 ^＋ T cells in CAEBV（40. 7% ） was not dramatically different from the healthy control group （48.3%） , but was still higher than that of AEBV group （21.0%） （P 〈0. 05） . Although the regulatory subset in CAEBV group（5.0% ）was higher than the health control group（4.6% ） （ P 〈 0. 05 ）, but lower than AEBV group （5.8%） （P 〈 0. 05 ）. In CAEBV, the proportion of CD4^＋/CD8^＋ nalve T cells （ 32. 3 %/37. 5% ） was lower than that of normal group （ 58.3 % / 56. 6% ）（ P 〈 0. 05 ）, but the proportion of CD4^＋CD8^＋ effective memory T cells in CAEBV group （23.9%/15.1%）was lower than that in AEBV group（36. 5%/69.8% ） （P 〈0.05）, while the proportion of CD8^＋ fake naYve T cells in CAEBV（ 17. 5% ）was higher than the other 2 groups（P 〈0. 05）. The CD8^＋ aetivatory subset in CAEBV group （ 84. 4%/34. 0% ） was higher than that of the healthy control group （44. 1%/16.7 % ） （ P 〈 0.05 ）, but still lower than AEBV group （ 96%/95 % ） （ P 〈 0. 05 ）. Conclusion There is an imbalance in lymphocyte subsets and disturbance in cellular immunity in CAEBV patients, which may be associated with EBV chronic active infection. Detecting the peripheral haematologic parameters and lymphocyte subsets may be helpful in the diagnosis and the differential diagnosis of CAEBV.