重症甲型H1N1流感病毒性肺炎支气管肺泡灌洗液淋巴细胞增高1例分析并文献复习

Pneumonia infected by influenza A/H1N1 virus induced lymphocytes rise in bronchoalveolar lavage fluid：A case report analysis and literature review

目的 探讨甲型H1N1流感患者外周血淋巴细胞绝对值减少及支气管肺泡灌洗液淋巴细胞增高是否与早期淋巴细胞归巢、中枢免疫器官功能抑制及淋巴细胞再循环障碍相关。 方法 整理1例经病毒核酸检测确诊为甲型H1N1流感病毒性肺炎患者的临床和实验室资料进行回顾性分析。 结果 患者缘于无明显诱因出现高热、咳嗽、咳痰、痰中带血，行CT平扫示两肺炎症。外周血淋巴细胞绝对值治疗前后比较无明显变化，其绝对值减少保持在低水平，而白细胞总数、中性粒细胞绝对值治疗前后比较有较大变化；支气管肺泡灌洗液细胞学检查淋巴细胞百分比为70%,其淋巴细胞明显增高且部分形态异形；支气管肺泡灌洗液流式淋巴细胞亚群CD3 ＋83.78%，CD3 ＋CD4 ＋28.67%，CD3 ＋CD8 ＋52.14%，CD3 ＋CD4 ＋/ CD3 ＋CD8 ＋0.55；支气管肺泡灌洗液病毒核酸检测H1N1阳性。临床予抗病毒及其他支持对症治疗，28天痊愈出院。 结论 甲型H1N1流感患者外周血淋巴细胞绝对值减少及支气管肺泡灌洗液淋巴细胞增高与早期淋巴细胞归巢、中枢免疫器官功能抑制及淋巴细胞再循环障碍相关。

Objective： To investigate whether the peripheral lymphocytes decline and the incremental of lymphocytes in bronchaolveolar lavage fluid has connection with the early of lymphocyte homing、central lymphoid organ immunity inhibition and lymphocyte recirculation dysfunction . Methods Collect the clinic and laboratory data from a patient infected influenza A/H1N1 confirmed by reverse transcription-polymerase chain reaction （RT-PCR） has analyzed retropectively. Results ： The patient had fever、cough、 phlegm and bloody sputum on unclear cause,the chest CT plain scan showed bilateral patchy pulmonary inflammation.The percentage of lymphocytes in the bronchoalveolar lavage fluid is 70%,which is increased obviously and part of the lymphocytes exists in the form of heteromorphism; the percentages of the lymphocyte subsets detected by flow cytometry are CD3 ＋83.78%,CD3 ＋CD4 ＋28.67%,CD3 ＋CD8 ＋52.14%,CD3 ＋CD4 ＋/ CD3 ＋CD8 ＋0.55; the influenza A virus nucleic acid is positive tested by RT-PCR; The peripheral blood absolute counts of lymphocytes before and after treatment have no obvious change and retain the low level; the absolute counts of total white cells and neutrophil granulocytes change significantly,the counts rise gradually as treatment and reach into normal range as the patient recovers.The patient treated with oseltaminvir combined with other supportive treatment and was discharged from the hospital after hospitalized for 28 days. Conclusion ： The peripheral blood absolute counts of lymphocytes decline and the percentages of lymphocytes incremental of bronchoalveolar lavage fluid has direct connection with the early of lymphocyte homing、central lymphoid organ immunity inhibition and lymphocyte recirculation dysfunction.