外周血淋巴细胞亚群在小儿肺炎合并急性呼吸窘迫综合征中的变化及临床价值

Changes and clinical value of peripheral blood lymphocyte subsets in pneumonia children complicated with acute respiratory distress syndrome

目的探讨外周血淋巴细胞亚群在小儿肺炎合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)中的变化及临床价值。方法回顾性分析2017年1月至2019年12月入住本院的55例小儿肺炎合并ARDS的临床资料,轻度组(13例)、中度组(24例)、重度组(18例)3个亚组。选取本院同期收治的小儿肺炎51例作为对照组。确诊第1 d检测外周血淋巴细胞亚群水平,比较小儿肺炎组和肺炎合并ARDS组、肺炎合并ARDS不同严重程度的活化淋巴细胞亚群水平的差异,探讨其变化及临床价值。结果肺炎合并ARDS组淋巴细胞计数为2.35×10^(9)/L、CD3+T细胞计数为(1570.42±1350.37)×10^(6)/L、CD4+T细胞计数为(951.05±868.61)×10^(6)/L、CD8+T细胞计数为397.01×10^(6)/L、CD19+B细胞计数为(956.33±933.99)×10^(6)/L、CD16+CD56+NK细胞计数为229.32×10^(6)/L,均低于小儿肺炎组,差异均有统计学意义(均P<0.05);不同严重程度ARDS患儿CD3+T细胞计数(F=11.64,P<0.001)、CD4+T细胞计数(F=14.00,P<0.001)、CD8+T细胞计数(χ^(2)=12.2,P<0.002)、CD4+/CD8+(F=4.98,P<0.011)比较,差异均有统计学意义。且随着病情严重程度增加,CD3+T细胞计数、CD4+T细胞计数、CD8+T细胞计数水平逐渐降低。结论小儿肺炎进展致ARDS过程中出现了免疫功能抑制,随着病情加重,T淋巴细胞亚群水平逐步降低,T淋巴细胞亚群有助于评估小儿肺炎合并ARDS病情严重程度。

Objective To investigate the changes and clinical value of peripheral blood lymphocyte subsets in pneumonia children complicated with acute respiratory distress syndrome(ARDS).Methods The clinical data of 55 pneumonia children complicated with ARDS admitted to our hospital from January,2017 to December,2019 were retrospectively analyzed.The children were divided into amild group(13 cases),amoderate group(24 cases),and a severe group(18 cases).51 pneumonia children admitted to our hospital concurrently were selected as a control group.Their peripheral blood lymphocyte subsets were detected on the first day of diagnosis.The levels of activated lymphocyte subsets were compared between the control group and the pneumonia with ARDS group and between the mild group,the moderate group;and the clinical value was explored.Results The lymphocyte count,CD3+T cell count,CD4+T cell count,CD8+T cell count,CD19+B cell count,and CD16+CD56+NK cell count were 2.35×10^(9)/L,(1570.42±1350.37)×10^(6)/L,(951.05±868.61)×10^(6)/L,397.01×10^(6)/L,(956.33±933.99)×10^(6)/L,and 229.32×10^(6)/L in the pneumonia children complicated with ARDS,which were lower than those in the control group(all P<0.05).There statistical differences in CD3+T cell count(F=11.64,P<0.001),CD4+T cell count(F=14.00,P<0.001),CD8+T cell count(χ^(2)=12.2,P<0.002),and CD4+/CD8+(F=4.98,P<0.011)between the mild group,the moderate group,and the severe group.The CD3+T cell count,CD4+T cell count,and CD8+T cell count gradually decreased with the increase of disease severity.Conclusion Immune suppression occurs in the process of ARDS caused by the progress of pneumonia in children and the levels of T lymphocyte subsets gradually decreased with the disease aggravation.T lymphocyte subsets are helpful to evaluate the severity of pneumonia complicated with ARDS in children.