儿童呼吸系统感染性疾病中淋巴细胞亚群的改变及临床价值

Changes and clinical value of lymphocyte subsets in children with respiratory infectious diseases

目的检测儿童常见呼吸系统感染性疾病病程中淋巴细胞亚群的改变,并探讨其在疾病中的特点及临床意义。评估CD4^+/CD8^+T细胞比值(T4/T8比值)在儿童呼吸系统感染性疾病诊断中的价值。方法选取儿科收治的呼吸系统感染性疾病患儿121例,包括上呼吸道感染36例,支气管炎33例,毛细支气管炎14例,肺炎38例。同时选取体检合格的健康儿童19例作为对照组。采用流式细胞术检测各组外周血淋巴细胞亚群百分比,并检测白细胞(WBC)、C反应蛋白(CRP)水平。结果儿童呼吸系统感染组CD4^+T细胞百分比、T4/T8比值、NK细胞水平降低,CD8^+T细胞百分比增高,差异有统计学意义(P<0.05),T细胞、B细胞百分比差异无统计学意义(P>0.05)。在上呼吸道感染、支气管炎、毛细支气管炎、肺炎组均可见不同程度的淋巴细胞亚群改变,以肺炎组改变最为明显。CRP、WBC、T4/T8比值诊断呼吸系统感染性疾病的受试者工作特征曲线(ROC曲线)曲线下面积依次为0.754、0.759、0.696。与CRP、WBC相比,T4/T8比值灵敏度略高,特异度较低。结论呼吸系统感染性疾病患儿普遍存在免疫功能受损现象,监测其淋巴细胞亚群的变化有助于了解患儿免疫功能,对治疗及预后有一定指导意义。血清T4/T8比值可与CRP水平及WBC联合检测,作为诊断儿童呼吸系统感染性疾病的临床检查指标。

Objective To observe the changes of lymphocyte subsets in children with respiratory infectious diseases,explore the characteristics and clinical significance,and to evaluate the diagnostic value of CD4^+/CD8^+T cell ratio(T4/T8 ratio)for children with respiratory infectious diseases.Methods A total of 121 children with respiratory infectious diseases were enrolled in the study from the department of pediatrics,including 36 cases of upper respiratory tract infection,33 cases of bronchitis,14 cases of bronchiolitis and 38 cases of pneumonia,meanwhile 19 healthy children were enrolled as control group.The percentage of peripheral blood lymphocyte subsets was detected by using flow cytometry,and WBC and CRP were also monitored.Results Compared with the control group,the percentage of CD4^+T cells,the T4/T8 ratio and the percentage of NK cells all significantly decreased,and the percentage of CD8^+T cells significantly increased in children with respiratory infection(P<0.05),meanwhile there was no significant difference in the proportion of T lymphocyte and B lymphocyte(P>0.05).In the upper respiratory tract infection,bronchitis,bronchiolitis and pneumonia groups,these changes can be seen in different degrees,especially in the pneumonia group.The area under the receiver operating characteristic curve(ROC curve)of CRP,WBC and T4/T8 ratios for diagnosing respiratory infectious diseases was 0.754,0.759 and 0.696,respectively.Compared with CRP and WBC,T4/T8 ratio was slightly more sensitive and less specific for diagnosing respiratory infectious diseases.Conclusion Immune impairment is common in children with respiratory infectious diseases.Monitoring the changes of lymphocyte subsets is helpful to understand the immune function of children,and can be used as a reference in the treatment and prognosis.Serum T4/T8 ratio can be combined with CRP and WBC as a diagnostic indicator of respiratory infectious diseases in children.