甲型、乙型流感病毒性肺炎患者的炎症反应及免疫细胞变化分析

Analysis of inflammatory reaction and immune cells changes in patients with influenza A or B viral pneumonia

目的:分析成人甲型、乙型流感病毒性肺炎患者的炎症细胞计数、炎性反应及免疫细胞的变化特征及其与病情发展的关系。方法:选取2018-01~2019-12在我院住院治疗的甲型和(或)乙型病毒性肺炎患者60例为研究对象,依据《中国成人社区获得性肺炎基层诊疗指南(2018年版)》的诊断标准,将患者分为普通组(n=46)和重症组(n=14)。比较两组不同时期的血常规、C-反应蛋白(C-reactive protein,CRP)及CD3+、CD4+、CD8+T淋巴细胞水平。结果:普通组平均年龄(46.3±12.5)岁,重症组平均年龄(62.8±14.7)岁,差异有显著统计学意义(P<0.01)。入院第1天,重症组外周血淋巴细胞及CD3+、CD4+、CD8+T淋巴细胞水平低于普通组(P<0.05),CRP水平明显高于普通组(P<0.05)。入院10~14 d普通组CRP水平恢复正常,外周血淋巴细胞计数及CD3+、CD4+、CD8+T淋巴细胞计数均较入院时明显升高,达到正常范围,差异有统计学意义(P<0.05)。重症组入院1周后病情加重,随着病情好转,CRP降低,中性粒细胞、外周血淋巴细胞计数及CD3+、CD4+、CD8+T淋巴细胞计数均升高(P<0.05)。结论:甲型、乙型流感病毒性肺炎重症患者以老年人居多,炎性反应增强和细胞免疫功能降低是其主要特征。通过监测炎症介质水平、淋巴细胞及免疫细胞状态有助于临床诊断及判断疾病的发展与预后。

Objective:To analyze the variation characteristics of inflammatory cell count,inflammatory reaction and immune cells in adult patients with influenza A or B viral pneumonia,and their relationship with the development of the disease.Methods:Sixty patients with influenza A or B viral pneumonia hospitalized in our hospital from January 2018 to December 2019 were selected,according to the diagnostic criteria of《guidelines for primary diagnosis and treatment of community acquired pneumonia in Chinese adults(2018 edition)》,they were divided into ordinary group(n=46)and severe group(n=14).The level of C-reactive protein(CRP)and CD3+,CD4+,CD8+T lymphocyte in peripheral blood at different periods between the two groups were compared.Results:The mean age of the ordinary group was(46.3±12.5)years old,and the severe group was(62.8±14.7)years old,the difference was statistically significant(P<0.01).On the day of admission,the peripheral blood lymphocytes,the levels of CD3+,CD4+and CD8+T lymphocytes in the ordinary group was lower than those in the severe group(P<0.05),and the level of CRP in ordinary group was higher than that in the severe group(P<0.05).After 10~14 d in hospital,the level of CRP in ordinary group returned to normal,and the T lymphocyte counts of CD3+,CD4+and CD8+were significantly higher than those at admission,and reaching the normal range,the difference was statistically significant(P<0.05).The condition of severe group was aggravated about one week after admission,and with the disease improves,the level of CRP was reduced,neutrophils,peripheral blood lymphoclytes and the levels of CD3+,CD4+,CD8+T lymphocytes were increased.Conclusion:Most severe patients with influenza A or B viral pneumonia are the elderly,and the enhancement of inflammatory reaction and the decrease of cellular immune function are the main characteristics of the disease.Monitoring the level of inflammatory mediators,lymphocytes and immune cells is helpful to clinical diagnosis and judge the development and prognosis of the disease.