T细胞亚群在轻症/重症甲型H1N1流感患者中的差异及临床意义

The difference of T lymphocyte subsets between mild type and severe type in patients infected with the 2009 pandemic influenza A （H1N1） virus and its clinical significance

目的 研究T淋巴细胞亚群在不同严重程度甲型H1N1流感患者中的差异及意义.方法 收集苏州大学附属第一医院2009年9月至2010年1月收治的66例经病毒检测确诊为甲型H1N1流感患者临床资料,按疾病严重程度及预后分为轻症治愈患者（B组,47例）、重症/危重症治愈患者（C组,14例）与死亡患者（D组,5例）,以同期正常人群（A组,20例）作为对照组,回顾性比较各组患者在发病后不同时间点外周血淋巴细胞计数及T淋巴细胞亚群（CD3＋,CD4＋,CD8＋）绝对值,检测方法采用流式细胞术;并比较各组患者的发热持续时间及病毒转阴时间.采用SAS9.13统计软件进行分析,多组间均数比较采用单因素方差及SNK法.结果 甲型H1 N1流感患者在发病初期即出现淋巴细胞计数以及T细胞亚群绝对值下降,与正常人群差异具有统计学意义（P＜0.05）,B、C两组随病情好转逐步上升,C组淋巴细胞计数及T细胞亚群绝对值显著低于B组（P＜0.05）,且C组恢复正常的时间晚于B组,而D组则持续偏低.三组患者发热时间/病毒转阴时间分别为（4.4±1.6）vs.（4.4±1.4）d、（12.9±3.1）vs.（10.2±2.6）d、（15.2±7.3）vs.（13.3±2.9）d,三组患者之间差异具有统计学意义（P＜0.05）.结论 患者感染甲型H1N1流感病毒后,导致细胞免疫功能严重受损,且外周血淋巴细胞计数及T淋巴细胞亚群的变化与疾病严重程度及预后存在紧密联系.本研究结果可以用于指导临床诊断治疗.

Objective To study the changes of subgroups of peripheral blood T lymphocytes in the patients infected with the 2009 pandemic influenza A （ H1N1 ） virus of different severity type. Method A total of 66 patients infected by H1N1 evidenced by RT-PCR admitted from September 2009 to January 2010 were divided into three groups： mild type （ B group, n = 47 ）, cured patients of severe and critical severe type （ C group, n = 14） and died patients （ D group, n =5）, according to the severity and prognosis. A total of 20 healthy volunteers served as control group（ A group）. Peripheral blood lymphocyte count, CD3＋,CD4＋ and CD8＋ T lymphocyte count were detected by flow cytometry at the different time points. Fever duration and H1N1 virus negative time were compared. Statistical analysis were performed by using SAS version 9.13 software and the data were processed with ANOVA and SNK test. Results Lymphocyte count, CD3＋,CD4＋ and CD8＋ T lymphocyte count declined in the early period in all the groups, and there were significant differences compared with A group （P〈0. 05）, while rised with the clinical progression in group B and C,and those of C group were lower than B group （ P 〈 0.05 ）, but those of D group were always low. Fever duration and H1N1 virus negative time were （4.4 ± 1.6） days vs. （4.4 ± 1. 4） days, （ 12.9 ± 3. 1 ） days vs.（ 10.2 ± 2.6） days and （ 15.2 ± 7.3 ） days vs. （ 13.3 ± 2.9 ） days respectively, and there were significant differences among the three groups （ P 〈 0.05 ）. Conclusions The cellular immune function was seriously damaged when patients were infected with H1N1. Further more, the changes of lymphocyte count, CD3＋ , CD4＋and CD8＋ T lymphocyte count were tightly related with the degree of severity and prognosis. These findings can be used for clinical diagnosis and treatment.