系统性红斑狼疮伴肺部感染患者外周血T淋巴细胞和NK细胞水平及其临床意义

Detection of peripheral blood T lymphocytes and NK cells and their clinical significance in patients with systemic lupus erythematosus complicated with pulmonary infection

目的分析系统性红斑狼疮(SLE)伴肺部感染患者外周血T淋巴细胞、自然杀伤(NK)细胞的检测水平及其临床意义。方法将2016年3月-2019年8月在天津市第五中心医院感染免疫科住院治疗的48例SLE合并肺部感染患者纳入SLE合并肺部感染组,另101例SLE未合并感染患者纳入SLE未合并感染组,另选取同期于医院健康体检中心年龄匹配的30名健康成年人作为健康对照组;比较三组T淋巴细胞、NK细胞及不同疾病活动状态下SLE合并肺部感染患者T淋巴细胞、NK细胞水平;并绘制受试者工作特征(ROC)曲线分析T淋巴细胞、NK细胞对SLE患者肺部感染的预测价值。结果 SLE未合并感染组和SLE合并感染组CD_(3)^(+)计数、CD_(4)^(+)计数、CD_(8)^(+)计数、CD_(4)^(+)/CD_(8)^(+)比值、NK细胞计数分别为(1 210.36±474.25)个/μl、(485.27±110.69)个/μl、(464.27±180.61)个/μl、(1.16±0.61)、(39.82±10.64)个/μl和(642.48±498.22)个/μl、(173.58±96.42)个/μl、(265.48±110.37)个/μl、(0.92±0.60)、(26.57±4.88)个/μl,低于对照组,且SLE合并感染组以上指标低于SLE未合并感染组(P<0.05);SLE稳定合并肺部感染患者和SLE活动合并肺部感染患者CD_(3)^(+)计数、CD_(4)^(+)计数、CD_(8)^(+)计数、CD_(4)^(+)/CD_(8)^(+)比值、NK细胞计数低于SLE稳定无肺部感染患者、SLE活动无肺部感染患者(P<0.05);T淋巴细胞、NK细胞预测SLE肺部感染时,以CD_(4)^(+)计数的AUC值最高,cut-off为331.69个/μl,其预测SLE肺部感染的敏感性、特异性为93.75%、96.04%。结论较单纯SLE患者,合并肺部感染患者T淋巴细胞、NK细胞明显偏低,并可在一定程度上对SLE肺部感染发挥一定预测价值,值得临床重视。

OBJECTIVE To analyze the levels and clinical significance of peripheral blood T lymphocytes and natural killer cells(NK cells) in patients with systemic lupus erythematosus(SLE) complicated with lung infection. METHODS A total of 48 patients with SLE complicated with lung infection who were hospitalized in the Department of Infection and Immunology of Tianjin Fifth Central Hospital from Mar. 2016 and Aug. 2019 were included in the SLE with pulmonary infection group, and the other 101 patients with SLE and without infection were included in the SLE uninfected group. Meanwhile, 30 healthy adults who were age-matched in the hospital health examination center during the same period were selected as healthy controls. Levels of T lymphocytes and NK cells in the three groups, and levels of T lymphocytes and NK cells in patients with different activity states of SLE complicated with lung infection were compared. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of T lymphocytes and NK cells for lung infection in patients with SLE. RESULTS The CD_(3)^(+), CD_(4)^(+) T cell, CD_(8)^(+) T cell count, CD_(4)^(+)/CD_(8)^(+) ratio and NK cell count in the SLE uncombined infection group and SLE combined infection group were(1 210.36±474.25)cell/μl,(485.27±110.69) cell/μl,(464.27±180.61) cell/μl,(1.16±0.61),(39.82±10.64) cell/μl, and 642.48±498.2 cell/μl, 2173.58±96.42 cell/μl, 265.48±110.37 cell/μl, 0.92±0.60, 26.57±4.88 cell/μl, respectively, significantly lower than those of the control group, and the above indicators in the SLE co-infection group were significantly lower than those in the SLE non-co-infection group(P<0.05). The CD_(3)^(+) count, CD_(4)^(+) T cell count, CD_(8)^(+) T cell count, CD_(4)^(+)/CD_(8)^(+) ratio and NK cell count of patients in both stable and active SLE combined with pulmonary infection group were significantly lower than those of patients in both stable and active SLE without lung infection group(P<0.05). Of T lymphocytes and NK cells, CD_(4)^(+) T cell count had the largest AUC for predicting lung infection in patients with SLE, and the cut-off value was 331.69 cell/μl, the sensitivity and specificity for predicting lung infection in patients with SLE were 93.75% and 96.04%, respectively. CONCLUSION Compared with those of patients with simple SLE, the T lymphocytes and NK cells of patients with lung infection were significantly lower, which can be used to predict lung infection in patients with SLE and deserved clinical attention.