新冠肺炎患者外周血T淋巴细胞亚群的变化及意义

Clinical significance of changes in peripheral blood T lymphocyte subsets in patients with coronavirus disease 2019

目的探讨外周血T淋巴细胞亚群在新型冠状病毒肺炎(COVID-19)患者中的变化及意义。方法回顾性分析2020年1月23日至3月10日武汉大学人民医院收治的507例COVID-19患者外周血淋巴细胞亚群变化。其中,普通型249例,重型217例及危重型41例。结果507例COVID-19患者中,普通型、重型及危重型患者外周血CD3^(+)、CD4^(+)、CD8^(+)T细胞数均存在差异,随着疾病程度加重,均呈下降趋势;与普通型相比,重型、危重型的CD3^(+)、CD4^(+)、CD8^(+)T细胞数显著降低,差异有统计学意义(P均<0.05),且危重型患者上述T淋巴细数目较重型下降更显著,差异有统计学意义(P<0.05);此外,341例COVID-19患者中,死亡病例组CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞数目较治愈组显著降低,差异有统计学意义(P均<0.01)。结论重型、危重型COVID-19患者细胞免疫功能损伤更显著,外周血T淋巴细胞亚群变化与COVID-19疾病分型及预后显著相关,有助于评估疾病严重程度及判断预后。

Objective To investigate the clinical significance of changes of peripheral blood T lymphocyte subsets in patients with coronavirus disease 2019(COVID-19).Methods The changes of lymphocyte subsets in peripheral blood of 507 patients with COVID-19 who were admitted to People's Hospital of Wuhan University on January 23,2020 and March 10,2020 were retrospectively analyzed.Among them,249 cases had common-type COVID-19,217 had severe-type,and 41 had critical-type.Results There were significant differences in the numbers of CD3^(+),CD4^(+),and CD8^(+)T cells in the peripheral blood among patients with common-type,severe-type,and critical-type COVID-19,and all showed a decreasing trend with the aggravation of disease degree.Compared with the common-type,the numbers of CD3^(+),CD4^(+),and CD8^(+)T cells in the severe-and critical-types were significantly decreased(P<0.05),and the numbers of the above T lymphocyte subsets in the critical-type were significantly lower than those in the severe-type(P<0.05).In addition,in 341 patients with COVID-19,the numbers of CD3^(+),CD4^(+),and CD8^(+)T lymphocytes in the death group was significantly lower than that in the cured group(P<0.01).Conclusion Cellular immune function impairment is more significant in patients with severe and critical COVID-19,and the changes of T lymphocyte subsets in peripheral blood are significantly correlated with the classification and prognosis of COVID-19,which is helpful to evaluate the severity of the disease and predict the prognosis.