三氯乙烯药疹样皮炎患者及健康接触工人外周血淋巴细胞亚群分析

Analysis of subgroups of lymphocyte in peripheral blood among dermatitis medicamentosa-like of trichloroethylene patients and healthy exposed workers

目的研究三氯乙烯（TCE）对接触工人淋巴细胞亚群的影响，寻找TCE药疹样皮炎早期的免疫学效应标志物。方法选取TCE药疹样皮炎患者28例（病例组），来自发生病例车间的健康TCE作业工人56名（接触组）和未从事过TCE作业的健康工人28名（非接触对照组）作为研究对象。所有研究对象采集静脉血2ml，EDTA抗凝处理，应用流式细胞技术检测淋巴细胞各亚群的百分比，结合血常规检测结果计算T细胞、CD4＋T细胞、CD8＋T细胞、B细胞、自然杀伤（NK）细胞绝对数及CD3＋CD4＋／CD3＋CD8＋比值，比较各组之间外周血淋巴细胞亚群的变化情况。结果病例组外周血淋巴细胞总数、T细胞、CD4＋T细胞、CD8＋T细胞绝对数（中位数依次为2810．00、1846．17、831．87、904．05个／ul全血）均明显高于接触组（中位数依次为2101．00、1218．59、643．87、482．81个／ul全血，Z值分别为-3．19、-4．96、-3．22、-4．99，P值均〈0．001）和非接触对照组（中位数依次为1900．00、1223．60、558．60、325．80个／ul全血，z值分别为-3．30、-4．46、-3．45、-5．03，P值均〈0．001）；病例组CD3＋CD4＋／CD3＋CD8＋比值和NK细胞绝对数（中位数分别为1．11、255．50个／ul全血）明显低于非接触对照组（中位数分别为1．96、642．60个／ul全血，z值分别为-3．11、-3．56，P值均〈0．01）；接触组CD8＋T细胞数（中位数为482．81个／ul全血）明显高于非接触对照组（中位数为325．80个／ul全血，Z=-2．63，P值〈0．01）；接触组CD3＋CD4＋／CD3＋CD8＋比值和NK细胞数（中位数分别为1．27、318．76个／ul全血）均明显低于非接触对照组（中位数分别为1．96、642．60个／ul全血，z值分别为-2．29、-3．52，P值均〈0．05）。结论TCE接触可导致作业工人外周血淋巴细胞亚群发生变化；总淋巴细胞、T细胞和CD4＋T细胞计数升高可作为TCE药疹样皮炎早期的免疫学效应标志物。

Objective To study the effects of trichloroethylene （TCE） to lymphocyte subsets among exposed workers, and explore the early immunological effect biomarkers for prevention of hypersensitivity dermatitis induced by TCE. Methods Twenty-eight patients with TCE-induced hypersensitivity dermatitis, 56 healthy TCE-exposed workers from the same workshops with patients, and 28 comparable unexposed controls were recruited in this study. The total lymphocyte count and the major lymphocyte subsets including T cell, CD4＋ T cell, CD8 ＋ T cell, B cell, NK cell in peripheral blood were measured by Flow Cytometer analysis and Standard blood count analysis. Results The total lymphocyte count and T cell, CD4＋ T cell, CD8 ＋ T cell among patients （median at 2810.00,1846.17,831.87,904.05 cell counts/ul blood） were significantly increased compared with TCE-exposed workers （ median at 2101.00,1218.59,643.87,482.81 cell counts/ul blood,Z = -3.19, -4.96, -3.22, -4.99,P 〈 0. 001 ） and unexposed controls （ median at 1900.00,1223.60,558.60,325.80 cell counts/ul blood, Z = - 3.30, - 4.46, - 3.45, - 5.03, P 〈 0. 001 ） ,the NK cell and CD3 ＋ CD4 ＋/CD3＋ CD8 ＋ ratio among patients （ median at 255.50 cell counts/ul blood and 1. 11 ） were significantly deereased compared with the unexposed eontrols（ median at 642.60 cell counts/ul blood and 1.96,Z = - 3.56 and - 3.11 ,P 〈 0.01 ）. Meanwhile, for the exposed workers,the CD8 ＋ T cell （median at 482.81 cell counts/ul blood） was significantly increased and the NK cell and CD3＋ CD4＋/CD3 ＋ CD8＋ ratio （ median at 318. 76 cell counts/ul blood and 1. 27 ） were significantly decreased compared with unexposed controls （ median at 325.80 and 642.60 cell counts/ul blood and 1.96, Z = - 2.63, - 3.52, - 2.29, P 〈 0.05 ）. Conclusion Occupational exposure to TCE could affect the lymphocyte subsets, especially T cell and NK cell. The total lymphocyte count, T cell and CD4＋ T cell might be effect biomarkers for subjects with hypersensitivity dermatitis among TCE-exposed workers.