甲型H1N1流感危重症患者淋巴细胞亚群和CD4^+CD25^+调节性T细胞的检测及其意义

Lymphocyte subpopulation and CD4^+CD25^+Treg signature analysis of patients with severe influenza A(H1N1) virus infection

目的观察甲型H1N1流感(甲流)危重症患者外周血白细胞(WBC)、淋巴细胞(L)、中性粒细胞(N)、淋巴细胞亚群及CD4+CD25+调节性T细胞的变化,探讨外周血淋巴细胞亚群及CD4+CD25+调节性T细胞在危重症甲流发病机制中的作用。方法对8例甲流危重症患者和10例健康对照外周血WBC进行检测,并用流式细胞术对其淋巴细胞亚群及CD4+CD25+调节性T细胞进行检测。结果患病初WBC正常者5例,降低者3例,以L降低为主,最低达0.60×109/L。病程中8例患者WBC和N均明显升高,WBC最高达36.42×109/L,N最高达33.27×109/L;甲流危重症患者CD3+(55.13±16.16)%、CD4+(27.25±9.51)%显著低于正常对照组(P<0.05);B细胞(CD19)、NK(CD16+CD56+)细胞、CD8+及CD4/CD8比例较健康对照组下降,但差异无统计学意义;患者CD4+CD25highCD127LowT细胞(1.81±1.25)%稍低于与健康对照组,差异无统计学意义(P>0.05);但8例甲流危重症中有6例孕妇,1例死亡患者的CD4+CD25highCD127LowT细胞含量为本研究中最高。结论甲流危重症患者外周血CD3+、CD4+细胞数量显著降低、CD4+CD25+调节性T细胞及CD4/CD8下降,提示细胞免疫异常可能在甲流危重症的发病机制中起重要作用;淋巴细胞亚群及CD4+CD25+调节性T细胞数量的检测可作为监测甲流患者免疫功能的指标,对于患者的治疗和预后有重要的参考价值。

Objective To observe the changes of white blood cells（WBC）,lymphocyte（L）,neutrophilic leukocyte（N）,lymphocyte subpopulation（including T,B lymphocyte,NK cells）and CD4＋CD25＋ regulatory T cells in patients with severe influenza A（H1N1）virus infection.To investigate the role of peripheral blood lymphocyte subpopulation and CD4＋CD25＋ regulatory T cells in the pathogenesis of patients with severe H1N1 virus infection.Methods The white blood cells were assayed in 8 patients with severe H1N1 virus infection and 10 normal control（NC）,T lymphocyte subpopulation and CD4＋CD25＋ regulatory T cells population in peripheral blood were also assayed by flow cytometry.Results In the initiation of the disease,5 patients＇ white blood cells counts were normal and 3 patients＇ were low.The lymphocyte decreased significantly,the minimum was 0.60 × 109/L.In the course of the disease,eight patients＇ white blood cells counts and neutrophilic leukocyte counts increased significantly,the maximum of WBC counts was 36.42 × 109/L,the maximum of neutrophilic leukocyte counts was 33.27 × 109/L.The levels of CD3＋（55.13 ± 16.16）% and CD4＋（27.25 ± 9.51）% in severe patients were significantly lower than that in NC（P0.05）.B lymphocyte（CD19）,NK cells（CD16＋CD56＋）,CD8＋ cells and CD4/CD8 in severe patients were also lower than that in NC,but there were no significant differences（P0.05）.CD4＋CD25highCD127Low T cells in severe patients（1.81 ± 1.25）% were slightly lower than that in NC,but the differences were not significant in statistics（P 0.05）.There were 6 pregnant women and 1 death patient among the 8 patients,the death one had the highest level of CD4＋CD25highCD127Low T cells.Conclusions CD3＋,CD4＋,CD4＋CD25＋ regulatory T cells and CD4/CD8 decrease in severe patients,which suggest that the abnormality of cellular immunity might play important role in the pathogenesis of severe H1N1 virus infection;T lymphocyte subpopulation and CD4＋CD25＋ regulatory T cells can be an index in monitoring patients＇ immunity condition,treatment and prognosis.