危重型新型冠状病毒肺炎患者T淋巴细胞亚群分析

Analysis of T lymphocyte subsets in critical COVID-19 patients

目的:初步探讨危重型新型冠状病毒肺炎(COVID-19)患者的免疫反应特点.方法:纳入深圳市第三人民医院2020年1月11日至2月5日收治的COVID-19患者152例,根据临床分型标准分为危重型组(17例)、重型组(31例)和普通型组(104例),采用回顾性分析,对比3组患者间T淋巴细胞亚群和白介素-6(IL-6)的差异,多因素Logistic回归分析危重型COVID-19危险因素.对危重型组进行亚组分析,根据目前临床结局分为死亡组(3例)和生存组(14例),分析不同时间节点T淋巴细胞亚群及IL-6变化趋势.结果:与普通型组比较,危重型组淋巴细胞计数、CD4^+T淋巴细胞计数、CD8^+T淋巴细胞计数较低(P<0.05),IL-6质量浓度较高(P<0.05).与重型组比较,危重型组IL-6质量浓度较高(P<0.05).多因素Logistic回归分析显示CD4^+T淋巴细胞计数减少(OR=-0.011;95%CI为0.979~0.999;P=0.031),IL-6质量浓度升高(OR=0.069;95%CI为1.010~1.136;P=0.022)是危重型COVID-19的独立危险因素.危重型亚组分析:死亡组病程中淋巴细胞计数、CD4^+T淋巴细胞计数、CD8^+T淋巴细胞计数持续偏低;生存组病程中淋巴细胞计数、CD4^+T淋巴细胞计数、CD8^+T淋巴细胞计数逐步恢复正常.死亡组病程后期IL-6质量浓度明显升高;生存组病程中IL-6质量浓度逐步恢复正常.结论:新型冠状病毒感染能够引起机体细胞免疫反应,特别是T淋巴细胞免疫反应.CD4^+T淋巴细胞、CD8^+T淋巴细胞持续偏低,IL-6质量浓度持续升高与病情恶化明显相关,可能提示预后不良.

Objective:To investigate the characteristics of inflammation and immune response in critical COVID-19 patients.Methods:152 COVID-19 patients who were admitted to Shenzhen Third People's Hospital from January 11 to February 5,2020 were analyzed.According to the clinical classification criteria,they were divided into critical group(17 cases),severe group(31 cases)and general group(104 cases).Retrospective analysis was used to compare the differences in T lymphocyte subsets and IL-6 among the three groups.Multivariate Logistic regression was used to analyze the risk factors in critical COVID-19.The critical group was divided into two subgroups of death group(3 cases)and survival group(14 cases)according to clinical outcome.The change trend of T lymphocyte subsets and IL-6 at different time periods was analyzed.Results:Compared with the general group,the lymphocyte count,CD4^+T lymphocyte count and CD8^+T lymphocyte count were lower whereas the IL-6 level was higher in critical group(P<0.05).Compared with the severe group,the IL-6 level was higher in critical group(P<0.05).Multivariate logistic regression analysis showed that the decreased CD4^+T lymphocyte count(OR=-0.011;95%CI 0.979~0.999;P=0.031)and the increased IL-6 level(OR=0.069;95%CI 1.010~1.136;P=0.022)were independent risk factors for critical COVID-19.Subgroup analysis of critical group showed that the lymphocyte count,CD4^+T lymphocyte count,and CD8^+T lymphocyte count remained low in the course of disease of patients in death group whereas these indexes gradually recovered to normal level in patients of survival group.In death group,the IL-6 level increased significantly in the late stage of disease.The IL-6 level gradually recovered to normal in survival group.Conclusion:SARS-CoV-2 infection may cause the response of body's cellular immune system,especially the T lymphocyte immune response.The continued low CD4^+T lymphocyte count and CD8^+T lymphocyte count and persistently rising IL-6 level were associated with disease progression,which may indicate a poor prognosis.