不同临床分型的COVID-19患者外周血免疫细胞水平分析

Analysis of peripheral blood immune cells in COVID-19 patients with different clinical types

目的分析新型冠状病毒肺炎(COVID-19)不同临床分型患者外周血免疫细胞水平,为COVID-19的诊疗工作提供数据支持。方法回顾分析2020年1月18日至2月20日在该中心治疗的94例COVID-19患者的临床资料。依据患者的临床分型将患者分为轻型和普通型组(轻普型组)68例,重型和危重型组(重危型组)26例。选取同期体检健康人员50例作为对照组。分析外周血不同免疫细胞在3组研究对象间的差异。采用受试者工作特曲线(ROC曲线)评价外周血免疫细胞、中性粒细胞/淋巴细胞比值(NLR)、中性粒细胞/CD8^+T淋巴细胞比值(N8R)以及中性粒细胞/CD4^+T淋巴细胞比值(N4R)对COVID-19患者临床分型的诊断价值。结果COVID-19患者的中性粒细胞和单核细胞水平高于对照组,而淋巴细胞水平则明显低于对照组(P<0.05);重危型组患者外周血CD3^+T细胞、CD3^+CD4^+T细胞、CD3^+CD8^+T细胞水平均低于轻普型组患者(P<0.05)。ROC曲线分析显示,各指标诊断COVID-19患者临床分型的曲线下面积(AUC)由大到小依次为N4R>NLR>CD3^+CD4^+T细胞>淋巴细胞>CD3^+T细胞>N8R>CD3^+CD8^+T细胞>中性粒细胞。结论COVID-19患者的外周血淋巴细胞数量降低,且重症患者淋巴细胞水平显著低于轻症患者;外周血免疫细胞的检测水平可用于COVID-19患者临床分型的辅助诊断。

Objective To analyze the levels of peripheral blood immune cells in patients with different clinical subtypes of Corona Virus Disease 2019(COVID-19),so as to provide data support for the diagnosis and treatment of COVID-19.Methods The clinical data of 94 patients with COVID-19 treated in Public Health Clinical Medical Center of Chengdu from January 18,2020 to February 20,2020 were retrospectively analyzed.The mild patients were selected as mild group(n=68),and critical patient were selected as critical group(n=26).In addition,50 healthy people were selected as control group.The differences of different peripheral blood immune cells in different groups were compared.The ROC curve was used to evaluate the predictive value of neutrophil lymphocyte ratio(NLR),neutrophil/CD8^+T lymphocyte ratio(N8R)and neutrophil/CD4^+T lymphocyte ratio(N4R)in patients with severe COVID-19.Results The number of neutrophils and monocytes in peripheral blood of COVID-19 patients was significantly higher than the control group(P<0.05),while the number of lymphocytes was significantly lower than the control group(P<0.05).The numbers of CD3^+T cells,CD3^+CD4^+T cells and CD3^+CD8^+T cells in critical group were significantly lower than those of mild group(P<0.05),while the N4R,NLR and N8R of critical group were higher than those of mild group(P<0.05).The ROC analysis of the prognostic factors of COVID-19 showed that the AUC was N4R>NLR>CD3^+CD4^+T cells>CD3^+T cells>N8R>CD3^+CD8^+T cells>neutrophils.Conclusion The number of peripheral blood lymphocytes in COVID-19 patients has decreased,which of severe patients has been lower than that of mild patients.N4R,NLR and the lymphocyte counts can be used as predictors of severe COVID-19.