新型冠状病毒肺炎患者中性粒细胞/淋巴细胞比值及细胞活化水平的研究

Neutrophil to lymphocyte ratio and cell activation lever in the peripheral blood of COVID⁃19

目的探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)对新型冠状病毒肺炎(COVID⁃2019)预后的预测价值。方法采用回顾性分析2020年2月至2020年3月湖北医药学院附属襄阳市第一人民医院救治的COVID⁃19感染患者20例,根据临床特征及病情分为普通组(包括普通型和轻型10例),重度组(包括重型和危重型10例)。收集患者入院后当天、1周后和出院时实验室检测和流式细胞术检测结果,计算NLR、ΔNLR1(入院1周后NLR⁃入院当天NLR)、ΔNLR2(入院后l周NLR⁃出院时NLR),比较两组上述指标的差异。流式细胞仪检测两组患者外周血中淋巴细胞、中性粒细胞、单核细胞的散点分布特征,及中性粒细胞表面标记CD15、T细胞活化的标记抗原HLA⁃DR阳性率。结果两组的NLR在治疗期间有显著变化,重度组的NLR在治疗1周时升高更明显,治愈出院时,两组患者的NLR都有显著下降。普通组CD15+中性粒细胞频数相对重度组较低,治疗期间没有显著波动,重度组CD15+中性粒细胞频数在治疗1周时明显升高,在治愈出院时显著下降;两组的HLA⁃DR+T细胞频数在治疗期间均有动态的显著变化,在治疗1周时明显升高,治愈出院时都有显著下降,而且在每个检测时间点都有组间差异。结论动态监测NLR、CD15+中性粒细胞频数、HLA⁃DR+T细胞频数可反映COVID⁃19的病情和预后。

Objective To investigate the predictive value of neutrophil to lymphocyte ratio on the prognosis of COVID⁃2019.Methods Twenty patients with SARS⁃coV⁃2 infection treated in Xiangyang NO.1 People′s Hospital affiliated to Hubei University of Medical from February 2020 to March 2020 were retrospectively analyzed.They were divided into moderate group(including normal and light 10 cases)and severe group(including severe and critical 10 cases),according to clinical characteristics and conditions.Laboratory tests and flow cytometry results were collected on the day after admission,1 week after admission and leaving hospital,and calculated the neutro⁃phn to lymphocyte ratio(NLR),ΔNLR1(NLR of 1 week after admission⁃NLR of admission),ΔNLR2(NLR of leaving hospital⁃NLR of 1 week after admission),compared the differences between the two groups.Flow cytome⁃try was used to detect the scattered distribution of lymphocytes,neutrophils and monocytes in peripheral blood of the two groups of patients,the positive rate of HLA⁃DR on T cells and CD15 on the surface of neutrophils as a marker of activation.Results There was a significant change in the NLR of the two groups during treatment.The NLR of the severe group increased more significantly at 1 week of treatment.When the patients were cured and discharged,the NLR of both groups decreased significantly.The frequency of CD15+neutrophils in the moderate group was relatively lower than that in the severe group,and there was no significant fluctuation during treatment.The frequency of CD15+neutrophils in the severe group increased significantly during 1 week of treatment,and decreased significantly when cured and discharged;The frequency of HLA⁃DR+T cells in both groups had a dynamic and significant change during the treatment period,which increased significantly at 1 week of treatment,and decreased significantly when cured and discharged,and there were differences between the groups at each time point of detection.Conclusion Dynamic monitoring of NLR,CD15+neutrophil frequency,and HLA⁃DR+T cell frequency can reflect the condition and prognosis of COVID⁃2019.