职业性三氯乙烯药疹样皮炎患者外周血T和B淋巴细胞分析

Peripheral T and B lymphocytes in patients with occupational medicamentosa-like dermatitis due to trichloroethylene

目的以职业性三氯乙烯药疹样皮炎(OMDT)患者为研究对象,分析治疗前后患者肝功能及外周血调节性淋巴细胞的变化特点。方法于2019年12月,以2017年2月至2019年2月期间收治的16例OMDT患者(其中8例为多形红斑,8例为重症多形红斑)为研究对象,检测患者治疗前后的肝功能指标和外周血调节性淋巴细胞百分数,分析肝功能与外周血调节性T、B淋巴细胞的变化情况及两者之间的相关性。结果治疗前,试验组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆红素(TBIL)、直接胆红素(DBIL)和谷氨酰肽酶(GGT)高于健康对照组,总蛋白(TP)、白蛋白(ALB)和胆碱脂酶(CHE)低于健康对照组,差异均有统计学意义(P<0.05);治疗前,试验组患者淋巴细胞、CD4^+T细胞、调节性T细胞(CD4^+CD25^+Tregs)、调节性B细胞(CD19^+CD24^+CD27^+Bregs)百分数和CD4^+/CD8^+比值均低于健康对照组,CD8^+T细胞百分数高于健康对照值,差异均有统计学意义(P<0.05)。治疗前,患者肝功能指标ALT、AST、GGT、DBIL水平与CD4^+CD25^+Tregs、CD19^+CD24^+CD27^+Bregs、CD4^+T细胞百分数和CD4^+/CD8^+比值呈负相关(r=-0.386^-0.809,P<0.05),与CD8^+T细胞百分数呈正相关(除DBIL外)(r=0.503~0.568,P<0.05);TP、ALB水平与CD4^+CD25^+Tregs、CD19^+CD24^+CD27^+Bregs、CD4^+T细胞百分数呈正相关(r=0.351~0.784,P<0.05),ALB与CD8^+T细胞百分数呈负相关(r=-0.315,P<0.05),CHE与CD4^+CD25^+Tregs、CD19^+CD24^+CD27^+Bregs百分数、CD4^+/CD8^+比值呈正相关(r=0.390~0.527,P<0.05)。结论OMDT患者存在免疫功能紊乱,可能由调节性淋巴细胞失衡引起,其肝脏损害可能与CD8^+T细胞的增高、CD4^+T细胞、CD4^+CD25^+Tregs、CD19^+CD24^+CD27^+Bregs百分数和CD4^+/CD8^+的比值降低有关。

Objective To investigate the changes in liver function and peripheral regulatory lymphocytes before and after treatment in patients with occupational medicamentosa-like dermatitis due to trichloroethylene(OMDT).Methods In December 2019,16 patients with OMDT(8 patients with erythema multiforme and 8 with erythema multiforme major)who were admitted from February 2017 to February 2019 were enrolled as subjects.Liver function parameters and percentages of peripheral regulatory lymphocytes were measured before and after treatment,and the changes in liver function and peripheral regulatory T and B lymphocytes and their correlation were analyzed.Results Before treatment,compared with the healthy control group,the experimental group had significantly higher levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL)and gamma-glutamyl transpeptidase(GGT)and significantly lower levels of total protein(TP),albumin(ALB)and cholinesterase(CHE)(P<0.05).Compared with the healthy control group,the experimental group had significantly lower percentages of lymphocytes,CD4^+ T cells,CD4^+CD25^+ Tregs,CD19^+CD24^+CD27^+ Bregs and CD4^+/CD8^+ ratio,as well as a significantly higher percentage of CD8^+T cells(P<0.05).Before treatment,the levels of ALT,AST,GGT and DBIL were negatively correlated with the percentages of CD4^+CD25^+Tregs,CD19^+CD24^+CD27^+ Bregs,CD4^+T cells and CD4^+/CD8^+ratio(r=-0.386 to-0.809,P<0.05)and was positively correlated with the percentage of CD8^+T cells(except DBIL)(r=0.503-0.568,P<0.05).The levels of TP and ALB were positively correlated with the percentages of CD4^+CD25^+ Tregs,CD19^+CD24^+CD27^+ Bregs and CD4^+ T cells(r=0.351-0.784,P<0.05),ALB was negatively correlated with the percentage of CD8^+T cells(r=-0.315,P<0.05).CHE was positively correlated with the percentages of CD4^+CD25^+ Tregs,CD19^+CD24^+CD27^+ Bregs and CD4^+/CD8^+ratio(r=0.390-0.527,P<0.05).Conclusion Immune dysfunction is observed in patients with OMDT,which may be caused by the imbalance of regulatory lymphocytes.And liver injury may be associated with the increase of CD8^+ T cells and the reductions of percentages of CD4^+ T cells,CD4^+CD25^+ Tregs,CD19^+CD24^+CD27^+ Bregs and CD4^+/CD8^+ ratio.