新型冠状病毒肺炎重症患者的炎性指标及T淋巴细胞亚群情况分析

Inflammatory indexes and T lymphocyte subsets in patients with severe coronavirus disease 2019 pneumonia

目的分析新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症患者的炎性指标及T淋巴细胞亚群的变化及意义。方法从2020年1-3月在深圳市第三人民医院收治的COVID-19患者中选取重症患者63例作为重症组,轻症患者73例作为轻症组。使用SAS 9.4软件对两组患者的T淋巴细胞水平及炎性指标检测结果进行统计学分析。结果 COVID-19重症患者和轻症患者的炎症指标比较:中性粒细胞绝对值(N)[2.99(2.27~4.38)×10^9/L vs 2.29(1.72~3.00)×10^9/L]、降钙素原(PCT)[0.06(0.05~0.08) ng/ml vs 0.04(0.03~0.05)ng/ml]、超敏C反应蛋白(CRP)[27.00(10.86~52.95) mg/L vs 7.20(5.00~17.99)mg/L]、红细胞沉降率(ESR)[41.50(24.50~59.50)mm/L vs 20.00(12.00~39.00)mm/L]、白介素6(IL-6)[23.60(16.63~37.01) pg/ml vs 12.13(4.43~17.02)pg/ml],各指标重症组均显著高于轻症组,P均<0.05;淋巴细胞绝对值(L)重症组低于轻症组[0.97(0.66~1.21)×10^9/L vs 1.39(0.99~1.74)×10^9/L,Z=-4.466,P<0.05]。同轻症组比较,重症组CD3计数[522(352~726)个/μl vs 989(631~1 378)个/μl]、CD4计数[340(211~482)个/μl vs 547(385~769)个/μl]、CD8计数[178(110~250)个/μl vs 354(226~518)个/μl]低于轻症组,P均<0.05。重症组同轻症组比较,各指标异常比例:L(66.67%vs 39.73%)、PCT(17.46%vs 2.74%)、CRP(79.37%vs 43.84%)、ESR(65.08%vs 31.51%)和IL-6(57.14%vs 28.77%),重症组均高于轻症组,差异有统计学意义(P均<0.05)。重症组CD4/CD8计数比值的异常比例低于轻症组(23.81%vs 46.58%,χ2=0.604,P<0.05)。结论 COVID-19重症组患者炎症指标(N、PCT、CRP、ESR、IL-6)及T淋巴细胞水平与轻症组比较差异有统计学意义,通过检测COVID-19患者的N、PCT、CRP、ESR、IL-6及T淋巴细胞亚群水平可为临床的病情进行预估及对治疗提供指导。

Objective To analyze inflammatory indicators and T lymphocyte subsets in severe patients with coronavirus disease-19(COVID-19). Methods From January to March 2020, 63 patients with severe COVID-19 admitted to the Third People′s Hospital of Shenzhen were selected as the severe group, and 73 patients with mild disease were selected as the mild group.SAS 9.4 software was used for analyzing the results of inflammatory indicators and T lymphocyte subsets between the two groups. Results The absolute value of neutrophils(N),procalcitonin(PCT),hypersensitive C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and interleukin-6(IL-6)in the severe group of COVID-19 patients were higher than that in the mild group.Result comparisons were 2.99(2.27-4.38)×10^9/L vs 2.29(1.72-3.00)×10^9/L,0.06(0.05-0.08)ng/ml vs 0.04(0.03-0.05)ng/ml,27.00(10.86-52.95)mg/L vs 7.20(5.00-17.99)mg/L,41.50(24.50-59.50) mm/L vs 20.00(12.00-39.00) mm/L, 23.60(16.63-37.01) pg/ml vs 12.13(4.43-17.02)pg/ml,all P<0.05.The absolute value of lymphocytes(L)in the severe group was lower than that in the mild group,and the value was 0.97(0.66-1.21)×10^9/L vs 1.39(0.99-1.74)×10^9/L(Z=-4.466,P<0.05).The counts of CD3,CD4 and CD8 in the severe group were lower than that in the mild group,which were 522(352-726)cells/μl vs 989(631-1 378)cells/μl,340(211-482)cells/μl vs 547(385-769)cells/μl,and 178(110-250)cells/μl vs 354(226-518)cells/μl,respectively.The abnormal proportions of L,PCT,CRP,ESR and IL-6 in the severe group were higher than that in the mild group,and the values were 66.67% vs 39.73%,17.46% vs 2.74%,79.37% vs 43.84%,65.08% vs 31.51% and 57.14% vs28.77%respectively,all P<0.05.The abnormal proportion of CD4/CD8 count ratio in the severe group was lower than that in the mild group,and the value was 23.81%vs 46.58% (χ~2=7.604,P<0.05). Conclusions There are significant differences in inflammatory indicators(N,PCT,CRP,ESR,IL-6)and T lymphocyte levels in the severe group of COVID-19 patients compared with that in the mild group.The detection of N,PCT,CRP,ESR,IL-6 and T lymphocyte subsets in COVID-19 patients can provide guidance for clinical evaluation.