重型甲型H1N1流感患者外周血免疫细胞变化及其临床意义

Meamrement of peripheral blood immune cells in severe influenza A （HIN1） patients and its clinical significance

目的 通过动态观察重型甲型H1N1流感（重症及危重症）患者外周血淋巴细胞的数量变化,探讨患者的免疫病理机制及淋巴细胞亚群检测在甲型H1N1流感诊断中的临床意义.方法 采用流式细胞技术检测2009年10-12月在我院住院治疗的41例重症、危重症甲型H1N1流感患者和同期41例轻症患者的外周血T、B和NK细胞数量.结果 在发病初期,重症及危重症患者外周血总T细胞、CD8＋T细胞、NK细胞较轻症甲型H1N1流感患者显著降低（P＜0.01）,CD4＋T细胞较轻症患者降低（P＜0.05）;危重症患者总T细胞、CD4＋T细胞、CD8＋T细胞、NK细胞低于重症患者（P＜0.01）.恢复期重症及危重症甲型H1N1流感患者总T细胞、CD8＋T细胞低于轻症患者（P＜0.05）,NK细胞低于轻症患者（P＜0.01）,B细胞高于轻症患者（P＜0.05）.结论 重症及危重症甲型H1N1流感患者存在明显的细胞免疫损伤.

Objective To observe the changes of blood lymphocyte in severe influenza A （H1N1） patients, and to investigate the immunopathogenesis of the influenza A（ H1N1 ） patients and the clinical value of lymphocyte detection in influenza A （H1N1） diagnosis. Methods The changes of blood lymphocyte subs,ets （T cells, B cells, NK cells） were determined by the flow cytometer analysis in41 patients with serious and critical influenza A （H1N1） and 41 patients with mild influenza A（H1N1）. Results The counts of total T cells, CD4＋ T cells,CD8＋ T cells, NK cells all significantly decreased in acute phase of serious and critical patients compared with those in mild patients （total T cells, CD8＋T cells,NK cells, P〈0.01;CD4＋T cells, P〈0.05）. The counts of above cells in critical influenza A （ H1N1 ） patients were less than those in serious patients（P〈0.01）. As the conditions improved in serious and critical patients, the counts of total T cells, CD8＋T cells and NK cells were still less than those in mild patients（total T cells, CD8＋T cells, P〈0.05; NK cells, P 〈 0.01 ）. The counts of B cells were higher than that in mild individuals （ P〈0.05）. Conclus The patients with serious and critical influenza A （H1N1） are markedly impaired with cellular immunity.