成人甲型H1N1流感患者血清免疫学及炎性指标的变化及意义

Difference of immunological and inflammatory indices between mild type and severe type of adult pandemic（H1N1）patients

目的 研究成人甲型H1N1流感患者血清免疫学和炎性指标在病程中的变化趋势及轻/重症患者的差异.方法 检测解放军第三○二医院2009年1～12月收治的148例轻症和18例重症患者急性期和恢复期的外周血白细胞、淋巴细胞、单核细胞计数和CD4＋、CD8＋T淋巴细胞绝对值,C反应蛋白、血清补体C3、C4和CH50,血清免疫球蛋白IgA、IgM和IgG,分析这些指标的变化.结果 两组患者急性期淋巴细胞数量下降和单核细胞数量上升,恢复期淋巴细胞数量回升和单核细胞数量回落.急性期重症组T淋巴细胞数量、CD4＋和CD8＋T细胞绝对值均明显低于轻症组.急性期两组CRP均上升,重症组较轻症组升高更明显;恢复期两组CRP较急性期均明显回落,但轻症组的回复快于重症组.急性期多数患者CH50有轻微上升,重症组CH50高于轻症组.结论 淋巴细胞计数、CD4＋和CD8＋T细胞绝对值及CRP、CH50等指标有助于监测病情轻重和判断预后.

Objective To study the difference of immunological and inflammatory indices between mild type and severe type of adult pandemic（H1N1）patients. Methods White blood cell, lymphocyte,monocyte, CD4＋ and CD8 ＋ T lymphocyte counts, level of C3 and C4, CH50, immunoglobulin A/G/M and CRP from 166 pandemic（H1N1）patients during acute and recovery phases were recorded and analyzed.Results A lowered lymphocyte count and an elevated monocyte count were observed in both groups during acute phase. And both were corrected during recovery phase. The absolute values of CD4 ＋ and CD8 ＋ T lymphocytes were much lower in severe group than those in mild group. During acute phase, the level of creactive protein（CRP）was elevated in both groups while it was higher in the severe group than that in the mild group. During recovery phase, the CRP level fell after a rise in both groups while it was quicker in the severe group than that in the mild group. During acute phase, the majority of CH50 became mildly elevated.And it was higher in severe patients than mild ones. Conclusion Lymphocyte count, CD4 ＋ ＆ CD8 ＋ T lymphocyte counts and CRP ＆ CH50 values provide useful information for the diagnosis of pandemic （H1N1）and the evaluation of its severity.