重型甲型H1N1流感患者T淋巴细胞亚群变化分析

Analysis of the Changes of T-lymphocyte Subsets in Patients with Severe Influenza A（H1N1）

【目的】探讨重型甲型HINl流感患者T淋巴细胞亚群的动态变化。【方法】采用流式细胞仪对21例重型甲型H1N1流感患者（重症组病例12例，危重组病例9例）病程初期（入院24h）、病程中期（入院后10d）、恢复期（入院后30d）外周血T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋进行检测和统计分析。【结果】两组患者病程初期、病程中、恢复期CD3^＋、CD4^＋、CD8^＋T淋巴细胞计数均呈上升趋势，组内比较，差异均有统计学意义（P〈0．01～0．05）；重症组病程初期、病程中与恢复期CD3^＋、CD4^＋、CD8^＋比较，差异有统计学意义（P〈0．01～0．05），危重组病程初期与病程中CD3^＋、CD4^＋、CD8^＋比较，差异无统计学意义（P〉0．05），危重组恢复期与病程初期、病程中CD3’、CD4’、CI）8’比较，差异有统计学意义（P〈0．01～0．05）；危重组与重症组比较：病程初期、病程中、恢复期CD3^＋、CD4^＋、CD8^＋T淋巴细胞计数均低于重症组，差异均有统计学意义（P〈0．01～O．05）。【结论】重型甲型H1N1流感患者存在T淋巴细胞亚群免疫功能障碍，病程初期其CD3^＋、cD4^＋、CD8^＋即整体降低，表现为抑制状态，病情越危重抑制越明显；恢复期明显上升，提示重型甲型H1Nl流感患者T淋巴细胞亚群免疫功能抑制是暂时的、可逆的。

[Objective] To explore the dynamic changes of T-lymphocyte subsets in patients with severe influenza A. [Methods] The flow cytometry was used to detect and analyze T-lymphocyte subsets such as CD3^＋ , CD4^＋ and CD8^＋ ） in peripheral blood of 21 patients with severe influenza A（H1N1） including 12 cases in the severe group and 9 cases in the critical group in the initial period（24h after admission）, the middle period （10 days after admission） and the recovery period（30 days after admission）. [Results]The count of T-lymphocyte such as CD3^＋ , CD4^＋and CD8^＋ of patients in two groups in the initial period, middle period and recovery period had the trend of elevation, and there were significant differences between two groups（ P〈0. 01 0.05）. There was significant difference in CD3^＋ , CD4^＋ and CD8^＋in the severe group between the initial or middle period and recovery period（ P〈0. 01- 0. 05）, while there was no significant difference in CD3＋ , CD4＋ and CD8＋ in the critical group between the initial period and the middle period（ P 〉0.05）. There were significant differences in CD3^＋ , CD4^＋ and CD8^＋ in the severe group between the recovery period and the ini- tial or middle period（ P〈0.0-0.05）. The count of CD3^＋ , CD4^＋ and CD8^＋ in the critical group were lower than those in the severe group among all three periods, and there were significant differences between two groups（ P〈0.01-0.05）. [Conclusion] The patients with severe influenza A（H1N1） have immunity dysfunction of T-lymphocyte subsets. In the initial period, the inhibitory state which all CD3^＋, CD4^＋ and CD8^＋ are reduced is seen, and the suppression increases with the severity of patients＂ condition, and obviously increases in the recovery period. It implies that the immunologic suppression of T-lymphocyte subsets of patients with severe influenza ＇A（ HIND is temporary and reversible.