轻症和重症甲型H1N1流感患者免疫学特征比较分析

Comparative analysis of immunological characteristics of patients with mild and severe influenza A （H1 N1）

目的对比分析轻症和重症甲型H1N1流感患者的细胞免疫学特征，为该病的病情监测和治疗提供科学依据。方法收集2009年7月1日至2009年12月31日于宁波市第二医院及宁海县第一医院就诊并确诊为甲型H1N1流感的204名患者作为病例组，其中轻症组52例，重症组152例，选取同时期的26名健康志愿者作为对照组；采用流式细胞仪检测各组外周血淋巴细胞亚群，采用ELISA方法检测各组血清干扰素-γ（IFN-γ）及白细胞介素-4（IL-4）水平。结果 H1N1流感患者重症组外周血淋巴细胞计数降低显著，与健康对照组及轻症组患者比较差异均有统计学意义（P＜0．01）；重症组T淋巴细胞、NK细胞、CD4＋T及CD8＋T淋巴细胞计数、百分比均较轻症组显著降低（ P＜0．01），B淋巴细胞及CD4＋T/CD8＋T比值虽然较轻症组降低，但差异无统计学意义（P＝0．11，0．175）；轻症组和重症组血清IFN-γ水平均较健康对照组降低，但是重症组降低更为显著（与健康对照组和轻症组比较，P＜0．01）；同样，轻症组和重症组血清IL-4水平均较健康对照组降低，但各组间比较统计学差异均无显著性意义（P＞0．05）。结论甲型H1N1流感患者免疫功能的异常与病情轻重有一定关系，尤其是细胞免疫功能，监测患者的免疫功能变化，对于判断患者的病情有较好的参考价值。

Objective To comparatively analyze the immunological characteristics of patients with mild and severe influenza A （H1N1）, and to provide the evidence for condition monitoring and treatment . Methods 52 cases with mild influenza A （ H1N1）, 152 cases with severe influenza A （ H1N1） and 26 healthy subjects from July 1, 2009 to December 31, 2009 were enrolled in the study.Lymphocyte subsets in peripheral blood were analyzed by flow cytometry and the serum concentrations of interferon -γ（ IFN-γ） and interleukin-4 （IL-4） were detected by enzyme-linked immune-sorbent assay （ELISA）.Results The total lymphocyte counts were decreased obviously in patients with severe influenza A （ H1N1） than in mild pa-tients and in healthy subjects （P0.05）.Con-clusion Immune dysfunction in patients with influenza A （H1N1） infection is associated with the severity of disease, especially cellular immunity .Therefore, monitoring of the immune system is valuable for the diag-nosis of influenza A（H1N1） infection.