人腺病毒55型致成人肺炎的临床特征及外周血淋巴细胞亚群分析

Clinical characteristics and peripheral blood lymphocyte subsets of HAdV55 pneumonia in adult patients

目的分析人腺病毒55型(HAdV55型)肺炎成年患者的临床及外周血淋巴细胞亚群特征。方法回顾性纳入2016年12月—2018年5月某院收治的132例成人HAdV55型感染患者,包括38例肺炎患者(肺炎组)和94例上呼吸道感染患者(上感组),比较两组患者的临床及影像学特征。应用流式细胞仪分析肺炎(31例)、上感患者(38例)及健康对照(10例)外周血淋巴细胞亚群分布,动态观察肺炎(5例)和上感患者(3例)外周血T淋巴细胞亚群变化。结果与上感组比较,肺炎组患者咳痰比例更高,发热日数和住院时间更长,外周血白细胞和中性粒细胞计数降低,淋巴细胞比例和绝对计数升高(均P<0.05),胸部CT显示肺部病变主要集中于右肺(21/38,55.3%)。淋巴细胞亚群分析表明,肺炎患者CD4+T细胞、CD8+T细胞、NK细胞和B细胞比例均高于健康对照,与上感组患者比较,差异无统计学意义(P>0.05)。T淋巴细胞亚群动态分析显示,5例肺炎患者病程第3天CD3+T淋巴细胞计数降低,后逐渐升高,第18天恢复正常。结论HAdV55型成人肺炎患者咳痰较上呼吸道感染常见,右肺容易受累,宿主细胞免疫功能紊乱,动态监测外周血淋巴细胞亚群有助于评估病情。

Objective To analyze the clinical characteristics and peripheral blood lymphocyte subsets of HAdV55 pneumonia in adult patients.Methods 132 adult patients with HAdV55 infection in a hospital from December 2016 to May 2018 were retrospectively analyzed,including 38 patients with pneumonia(pneumonia group)and 94 patients with upper respiratory tract infection(URTI group),clinical and imaging characteristics of two groups of patients were compared.Flow cytometry was used to analyze the distribution of peripheral blood lymphocyte subsets in 31 patients with pneumonia,38 patients with URTI and 10 healthy controls,dynamic changes in peripheral blood T lymphocyte subsets in 5 patients with pneumonia and 3 patients with URTI were observed.Results Compared with URTI group,patients in pneumonia group had higher proportion of expectoration,longer fever days and hospitalization time,decreased peripheral blood white blood cell and neutrophil count,as well as increased lymphocyte proportion and absolute count(all P<0.05),chest CT showed that the lung lesions mainly focused on the right lung(21/38,5.3%).Lymphocyte subsets analysis showed that proportions of CD4+T cells,CD8+T cells,NK cells and B cells in patients with pneumonia were both higher than those in healthy controls,there was no significant difference compared with patients in URTI group(P>0.05).The dynamic analysis of T lymphocyte subsets showed that CD3+T lymphocyte count of 5 pneumonia patients decreased on the 3rd day of disease course,then increased gradually,and returned to normal on the 18th day.Conclusion Expectoration is more common in patients with HAdV55 adult pneumonia,right lung is easy to be affected,host cell immune function is disordered,dynamic monitoring on peripheral blood lymphocyte subsets is helpful to assess the disease condition.