CD4^(+)T淋巴细胞和CD8^(+)T淋巴细胞对新型冠状病毒肺炎的临床分型及其预后的价值

Value of CD4^(+)and CD8^(+)T-lymphocyte counts for clinical diagnostic classification and prognosis of coronavirus disease 2019

目的探讨CD4^(+)T淋巴细胞和CD8^(+)T淋巴细胞对新型冠状病毒肺炎(COVID-19)的临床分型及其预后的价值。方法纳入2020年1月至3月上海市(复旦大学附属)公共卫生临床中心收治的95例COVID-19患者,比较普通型、重型、危重型患者及临床转归为治愈、好转、未愈、死亡患者的CD4^(+)T淋巴细胞计数和CD8^(+)T淋巴细胞计数。采用受试者操作特征曲线下面积评估CD4^(+)T淋巴细胞计数和CD8^(+)T淋巴细胞计数对COVID-19临床分型及预后的价值。组间比较采用曼-惠特尼U检验。结果95例COVID-19患者中,普通型68例,重型11例,危重型16例。治疗前普通型、重型和危重型患者的CD4^(+)T淋巴细胞计数分别为419(309,612)、267(212,540)和141(77,201)/μL,CD8^(+)T淋巴细胞计数分别为238(153,375)、128(96,172)和92(51,144)/μL,差异均有统计学意义(Z=24.322、15.956,均P<0.01)。死亡、未愈、好转和治愈病例的CD4^(+)T淋巴细胞计数分别为149(143,349)、315(116,414)、344(294,426)和745(611,966)/μL,CD8^(+)T淋巴细胞计数分别为106(43,501)、176(67,279)、194(188,432)和429(276,564)/μL,差异均有统计学意义(Z=36.083、16.658,均P<0.01)。评估危重型患者的CD4^(+)T淋巴细胞计数最佳临界值为237/μL,曲线下面积为0.911[95%可信区间(confidence interval, CI) 0.833~0.989,P<0.01],灵敏度和特异度分别为86.1%和87.5%;评估(危)重型患者治疗有效性的CD4^(+)T淋巴细胞计数最佳临界值为405/μL,曲线下面积为0.863(95%CI 0.727~0.999,P=0.001),灵敏度和特异度分别为78.6%和74.6%。结论COVID-19的病情可能随CD4^(+)T淋巴细胞计数和CD8^(+)T淋巴细胞计数减少呈加重趋势,CD4^(+)T淋巴细胞计数可用作COVID-19临床分型诊断和评估(危)重型病例预后的指标。

Objective To assess the value of CD4^(+)and CD8^(+)T-lymphocyte counts for the diagnostic classification and prognosis of coronavirus disease 2019(COVID-19).Methods A total of 95 COVID-19 adult patients admitted to Shanghai Public Health Clinical Center,Fudan University from January to March 2020 were recruited.The CD4^(+)and CD8^(+)T-lymphocyte counts among ordinary,severe and critical patients,as well among the cured,improved,unimproved and death patients were compared.The area under receiver operating characteristic curve(AUROC)was used to evaluate the value of CD4^(+)and CD8^(+)T-lymphocyte counts for the clinical diagnosis and prognosis of COVID-19.The comparison among groups was performed by Mann-Whitney U test.Results A total of 95 COVID-19 cases including 68 common,11 severe and 16 critical cases were enrolled.The counts of CD4^(+)and CD8^(+)T-lymphocyte of patients in common,severe and critical groups were 419(309,612),267(212,540),141(77,201)/μL,and 238(153,375),128(96,172),92(51,144)/μL,respectively,with significant differences(Z=24.322 and 15.956,respectively,both P<0.01).The counts of CD4^(+)and CD8^(+)T-lymphocyte of the death,unimproved,improved,and cured patients were 149(143,349),315(116,414),344(294,426),745(611,966)/μL,and 106(43,501),176(67,279),194(188,432),429(276,564)/μL,respectively,with significant differences(Z=36.083 and 16.658,respectively,both P<0.01).The optimal cut-off point of CD4^(+)T-lymphocyte counts was 237/μL for critical COVID-19 with AUROC 0.911(95%confidence interval(CI)0.833-0.989,P<0.01),with the sensitivity of 86.1%and specificity of 87.5%.For predicting severe and critical cases,the optimal cut-off point of CD4^(+)T-lymphocyte counts was 405/μL with AUROC 0.863(95%CI 0.727-0.999,P=0.001),with the sensitivity of 78.6%and specificity of 74.6%.Conclusions The conditions of patients with COVID-19 are aggravated with CD4^(+)and CD8^(+)T-lymphocyte counts decreasing.CD4^(+)T-lymphocyte counts may be an indicator for diagnostic classification of COVID-19 and prognostic indicator for severe and critical patients.