吉兰-巴雷综合征患者血浆置换治疗前后外周血淋巴细胞亚群的变化

Changes of T-lymphocyte subsets in peripheral blood before and after plasmapheresis and its significance in patients with Guillain-Barré syndrome

目的分析吉兰-巴雷综合征(GBS)患者急性期治疗前后外周血淋巴细胞亚群的变化,探讨各淋巴细胞亚群变化在GBS发病中的作用和机制。方法选取2014年1月至2016年12月确诊GBS的患者20例,根据Hughes评分分为轻症组(12例)和重症组(8例),均给予血浆置换治疗;选择同期18例健康体检者作为对照组。应用流式细胞分析仪检测对照组及GBS患者治疗前后外周血中淋巴细胞亚群相对计数。结果 (1)治疗前重症组Hughes评分高于轻症组(P<0.01),治疗后轻症组与重症组Hughes评分均较治疗前下降(P<0.05,P<0.01);(2)治疗前,GBS组CD3+T淋巴细胞计数较对照组显著下降[(67.02±5.45)%vs(76.37±6.58)%,P<0.01],CD19+B淋巴细胞显著增高[(14.23±3.84)%vs(10.75±3.67)%,P<0.01]。治疗后,GBS组CD3+T细胞则较治疗前升高[(71.72±7.76)%vs(67.02±5.45)%,P<0.05];GBS组CD8+T细胞在治疗前后与正常对照组比较无统计学差异(P>0.05);治疗后CD4+/CD8+T淋巴细胞比值与治疗前相比升高(1.99±0.95 vs 1.38±0.47,P<0.05)。与对照组比较,治疗前,GBS组CD4+T细胞显著降低[(38.06±7.30)%vs(44.76±7.22)%,P<0.01];治疗后,GBS组CD4+T细胞再次恢复至与对照组相当水平[(44.47±8.79)%vs(44.76±7.22)%,P>0.05]。(3)治疗后,在重症组CD19+B淋巴细胞较治疗前下降[(11.69±2.65)%vs(15.16±3.55)%,P<0.05];轻症组与重症组CD4+T细胞较治疗前升高(P均<0.05)。CD4+CD25+T细胞在治疗前后无变化(P>0.05)。结论GBS急性期患者存在淋巴细胞亚群的异常分布,反映出免疫功能紊乱在GBS发病过程中起到了重要作用,监测外周血中淋巴细胞亚群有助于评估GBS患者机体免疫状态,判断疾病严重程度及预后。

Objective To analyze the changes of T-lymphocyte subsets in peripheral blood before and after plasmapheresis in acute stage of Guillain-Barré syndrome（GBS） patients and explore its role and mechanism in the pathogenesis of GBS.Methods Twenty confirmed GBS patients from January 2014 to December 2016 were selected（GBS group）. The patients were divided into mild group（n = 12） and severe group（n = 8） according to Hughes scoring,and the patients in both two groups received plasmapheresis. Eighteen healthy subjects were selected as control group. Flow cytometer was used to detect the relative count of lymphocyte subsets in peripheral blood for control group and for GBS group before and after plasmapheresis. Results Before treatment,Hughes score in severe group was significantly higher than that in mild group（P〈0. 01） and decreased significantly after treatment in both mild group and severe group（P〈0. 05,P〈0. 01）. Before treatment,CD3＋T cells decreased significantly [（67. 02 ± 5. 45） % vs（76. 37 ± 6. 58） %,P〈0. 01],and CD19＋B cells increased significantly [（14. 23 ± 3. 84） % vs（10. 75 ± 3. 67） %,P〈0. 01] in GBS group compared with control group.After treatment,CD3＋T cells in GBS group increased significantly compared with pre-treatment [（71. 72 ± 7. 76） % vs（67. 02 ± 5. 45） %,P〈0. 05]. Compared with control group,CD4＋T cells before treatment decreased significantly in GBS group[（38. 06 ± 7. 30） % vs（44. 76 ± 7. 22） %,P〈0. 01] and recovered back to the similar level with control group again after treatment [（44. 47 ± 8. 79） % vs（44. 76 ± 7. 22） %,P〈0. 05]. The ratio of CD4＋to CD8＋after treatment in GBS group increased significantly compared with pre-treatment（1. 99 ± 0. 95 vs 1. 38 ± 0. 47,P〈0. 05）. CD4＋T cells increased significantly after treatment in both mild group and severe group（all P〈0. 05）. CD19＋B cells in severe group decreased significantly compared with pre-treatment [（11. 69 ± 2. 65） % vs（15. 16 ± 3. 55） %,P〈0. 05]. CD4＋CD25＋T cells after treatment remained unchanged compared with pre-treatment（P〉0. 05）. There were no significant differences in CD8＋T cell counts in GBS group before and after treatment and control group（all P〈0. 05）. Conclusions There is an abnormal distribution of lymphocyte subsets in acute stage of GBS patients which shows that immune dysfunction plays an important role in the pathogenesis of GBS. Monitoring the distribution of lymphocyte subsets in peripheral blood is helpful to evaluate immune status in GBS patients and Judge the severity and prognosis of the disease.