新型冠状病毒肺炎患者白细胞介素-6 T淋巴细胞亚群及NK细胞变化分析

The changes of IL-6 T lymphocyte subsets and NK cells in the patients with coronavirus disease2019

目的探究新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者早期白细胞介素-6(IL-6)、T淋巴细胞亚群及NK细胞的变化。方法选取2020年1月至2020年4月在中国科学技术大学附属第一医院(感染病院)因发热疑似COVID-19住院患者64例,根据新型冠状病毒核酸检测的结果分为对照组(新型冠状病毒核酸检测阴性,n=16)和实验组(新型冠状病毒核酸检测阳性,n=48)。通过收集患者入院时新型冠状病毒核酸检测、白细胞计数(WBC)、中性粒细胞绝对值(NEU#)、淋巴细胞绝对值(LYM#)、C-反应蛋白(CRP)、降钙素原(PCT)、血沉(ESR)、IL-6、CD4/CD8、CD4绝对计数、CD8绝对计数、CD3绝对计数和NK细胞,并统计每一位患者与湖北省武汉市、湖北省武汉市以外的疫区或与来自湖北省武汉市、湖北省武汉市以外的疫区人员的接触史.结果对照组与实验组接触史、WBC、LYM#、ESR、CD4/CD8、CD4绝对计数、CD8绝对计数和NK细胞比较差异具有统计学意义(P<0.05),NK细胞ROC曲线下面积(AUC)为0.981,95%CI(0.963~1.000),敏感度100%,特异度88.1%,截点17.5;普通型与重型年龄、WBC、LYM#、CRP、ESR、IL-6、CD4/CD8、CD4绝对计数和NK细胞比较差异具有统计学意义(P<0.05),其中IL-6的差异更具有统计学意义(t=-29.45,P=0.00)。结论COVID-19患者早期的T淋巴细胞亚群及NK细胞水平存在异常,其中NK细胞变化明显,可能为深入研究COVID-19导致淋巴细胞减少机制提供新方向,并对疾病的诊断、病情评估具有一定的临床价值,在重症患者中IL-6可能具有一定的临床价值,用于指导重症患者治疗。

Objective To investigate the changes of interleukin-6(IL-6),T lymphocyte subsets and NK cells in the patients with coronavirus disease 2019(COVID-19).Methods 64 patients of suspected COVID-19 were selected in the First Affiliated Hospital of University of Science&Technology China(infection hospital)from January to April 2020.According to the results of the detection of the new coronavirus nucleic acid,the patients were divided into control group(negative detection,n=16)and the experimental group(positive detection,n=48).The novel coronavirus nucleic acid detection,white blood cell count(WBC),neutrophil absolute value(NEU#),absolute value of lymphocyte(LYM#),C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),CD4/CD8,CD4 absolute count,CD8 absolute count,CD3 absolute count,and NK cells were collected from patients on admission,and the contact history of each patient with the epidemic area or with the people from the epidemic area was counted.Results The differences of contact history,WBC,LYM#,ESR,CD4/CD8,CD4,CD8 and NK cells between the control group and the experimental group were statistically significant(P<0.05).The area under the ROC curve for NK was 0.981(95%CI 0.963-1.000)with a sensitivity of 100%,a specificity of 88.1%,and a cutoff of 17.5.The differences of age,WBC,LYM#,CRP,ESR,IL-6,CD4/CD8,CD4 and NK cells were statistically significant between the normal type and the severe type(P<0.05),the difference of IL-6 was more significant(t=-29.45,P=0.00).Conclusion Tlymphocyte subsets and NK cells level in the patients with COVID-19 are abnormal at the early stage,the changes of NK cells are obvious,which may provide a new direction for further study of the mechanism of lymphopenia caused by COVID-19,and may have certain clinical value in the diagnosis and evaluation of disease.IL-6 in severe patients can be used to guide the treatment of severe patients.