血常规及T淋巴细胞亚群在新型冠状病毒肺炎病程监测中的意义

Significance of blood routine and T lymphocyte subsets monitoring in course of coronavirus disease 2019

目的 观察新型冠状病毒肺炎(简称新冠肺炎)患者病程中外周血T淋巴细胞、血常规指标的变化情况,探讨其监测的意义.方法 2020年1月26日至3月2日,昆明市第三人民医院共收治确诊的新冠肺炎患者27例,其中重症组10例,轻症组17例.收集患者病程(7±1)、(10±1)、(14±1)、(20±1)d外周血T淋巴细胞亚群、白细胞计数(WBC)及分类计数等临床资料,观察两组不同时间点实验室指标的变化趋势;采用Spearmen相关性分析法分析发生重症时间与淋巴细胞计数(LYM)的相关性.结果 重症组新冠肺炎患者入院时LYM、嗜酸粒细胞计数(Eos)及CD3^+、CD4^+、CD8^+T淋巴细胞计数均明显低于轻症组〔LYM(×10^9/L):0.96±0.30比1.47±0.39,Eos(×10^9/L):0.006±0.001比0.051±0.004,CD3^+(个/μL):685.59±254.73比1084.31±306.66,CD4^+(个/μL):393.25±166.31比644.00±230.95,CD8^+(个/μL):251.08±112.28比389.94±118.52,均P<0.05〕.随病程进展,两组中性粒细胞计数(NEU)呈上升趋势,重症组于病程(14±1)d达峰值,且NEU明显高于轻症组(×10^9/L:6.96±4.29比3.24±1.12),随后两组呈迅速下降趋势;轻症组Eos呈上升趋势,于(20±1)d达峰值;重症组Eos于(10±1)d达谷值,且明显低于轻症组(×10^9/L:0.006±0.001比0.059±0.004,P<0.05),此后逐渐升高;LYM、CD3^+、CD4^+、CD8^+均于病程(10±1)d时达谷值,且重症组明显低于轻症组〔LYM(×10^9/L):0.78±0.30比1.44±0.48,CD3^+(个/μL):539.00±280.46比927.70±291.42,CD4^+(个/μL):299.29±146.38比539.00±189.49,CD8^+(个/μL):201.29±106.44比352.90±136.40,均P<0.05〕,此后开始升高,LYM、CD3^+、CD8^+于病程(20±1)d达峰值,重症组LYM、CD3^+仍低于轻症组〔LYM(×10^9/L):1.25±0.27比1.63±0.63,CD3^+(个/μL):1067.43±303.36比1107.70±413.25〕,CD8^+略高于轻症组(个/μL:421.29±194.70比400.70±179.98).相关性分析显示,发生重症时间与LYM呈显著负相关性(r=-0.754,P=0.012).结论 监测新冠肺炎患者病程(10±1)-(14±1)d的NEU对评估病情有一定的帮助,监测病程(10±1)d的Eos及CD3^+、CD4^+、CD8^+T淋巴细胞计数对病情评估有较高的价值,监测病程(10±1)d的LYM水平对重症患者病情预警有较高价值.

Objective To observe the changes of peripheral blood T lymphoeytes subsets and blood routine indexes in the course of coronavirus disease 2019(COVID-19),and explore the significance of monitoring the above changes.Methods The 27 patients with confirmed diagnosis of C0VID-19 in the Third People's Hospial of Kunming during January 26 to March 2,2020 were selected as research objeets,and they were divided into a severe group(10 cases)and a mild group(17 cases)according to the difference in disease severity degree.The clinical data such as T lymphoeyte subsets,white blood cell count(WBC)and its lasification in peripheral blood of patients with COVID-19 were ollected on the following days in the disease course(7±1),(10±1).(14±1)and(20±1)days in hospital to observe the laboratory indexes changing trends at above various time points in two groups;Spearman correlation analysis method was used to analyze the correlation between the oceurrence time of severe ilness and lymphocyte count (LYM),Results The LYM,eosinophil count(Eos)and CD3^+,CD4^+and CD8^+ T lymphocyte counts at admission in severe COVID-19 patient group were significantly lower than those in mild group[LYM(×10^9/L):0.96+0.30 vs.1.47±0.39,Eos(×10^9/L):0.006±0.009 vs.0.051±0.044,CD3^+(cells/μL):685.59±254.73 vs.1084.31±306.66,CD4^+(cells/μL):393.25±166.31 vs.644.00±230.95.CD8^+(cells/μL);251.08±112.28 vs.389.94±118.52.all P<0.05].With the progression of disease,the neutrophil count(NEU)of two groups showed an upward trend,in the severe group,the NEU level reached the peak value on(14±1)days of disease course,and the NEU count was higher than that in mild group(×10^9/L:6.96±4.29 vs.3.24±1.12).then afterward the two groups showed rapid downward trend in two groups;Eos in the mild group showed an upward trend and reached the peak on(20±1)day;in the severe group,Eos reached the valley value on(10±1)day,which was significantly lower than that in the mild group(×10^9/L:0.006±0.001 vs.0.059±0.004,P<0.05),and then gradually increased;the levels of LYM,CD3^+.CD4^+.and CD8^+ reached the valley value on(10±1)day of the disease course in both groups,and the above indexes in severe group was significantly lower than those in the mild group[LYM(×10^9/L):0.78±0.30 vs.1.44±0.48,CD3^+(celIs/μL):539.00±280.46 vs.927.70±291.42.CD4^+(celIs/μL):299.29±146.38 vs.539.00±189.49.CD8^+(celIs/μL);201.29±106.44 vs.352.90±136.40,all P<0.05].Afterwards,the indexes began to increase and LYM,CD3^+.CD8^+ reached the peak value on day(20±1)of disease course,LYM and CD3^+ were still lower in severe group than those in mild group[LYM(×10^9/L):1.25+0.27 vs.1.63+0.63,CD3^+(celIs/μL):1067.43±303.36 vs.1107.70±413.25,CD8^+ was slightly higher than that in mild group(celIs/μL:421.29±194.70 vs.400.70±179.98).Correlation analysis showed that the time of occurrence of severe ilness was negatively correlated with LYM(r=-0.754,P=0.012)].Conclusion Monitoring NEU in patients with COVID-19 during(10±1)-(14±1)days in the disease course has certain help for the assessment of disease situation,on(10±1)day in the disease course,monitoring of Eos and CD3^+,CD4^+and CD8^+ T-lymphocyte counts has relatively good value for disease situation assessment,and monitoring of LYM level on(10±1)day of disease course has relatively high value of pre-warming for severe patients with COVID-19.