海口地区恙虫病患者免疫损伤及临床特征分析

Analysis of immune damage and clinical characteristics of tsutsugamushi disease in Haikou,Hainan Province

目的分析海南海口地区恙虫病患者免疫损伤及临床特征。方法选取海南海口地区2015年1月至2020年1月诊断恙虫病的患者297例,纳入患者组;并选取同期100名健康体检者,纳入对照组。对比患者组、对照组外周血淋巴细胞、自然杀伤(NK)细胞、炎性因子水平差异,并分析患者组临床特征。结果患者组CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD8^(+)T淋巴细胞水平高于对照组,患者组NK细胞、CD19^(+)B淋巴细胞水平低于对照组,差异有统计学意义(P<0.05)。患者组IL-6、IL-8、IL-18、IL-15、TNF-α、IFN-γ水平均高于对照组,差异有统计学意义(P<0.05)。患者临床表现以发热、焦痂或溃疡、畏寒为主,分别占100.00%、90.91%、70.03%。患者OT基因型以Karp型为主,占62.63%,其次为Gilliam型,占17.85%。同源性分析结果示,297例恙虫病患者恙虫病东方体(OT)代表株与台湾KM08、KM05同源性较高。结论海南海口地区恙虫病患者存在明显免疫损伤,并以体液免疫增强、细胞免疫减弱及促炎因子大量释放为主,患者临床表现特异性有限,其OT基因型呈现多样性但以Karp型为主,来源亦较为复杂。

Objective To analyze the immune damage and clinical characteristics in patients with tsutsugamushi disease in Haikou,Hainan Province.Methods 297 patients diagnosed with tsutsugamushi disease from January 2015 to January 2020 in Haikou District of Hainan Province were selected and included in the patient group,and 100 healthy persons in the same period were selected as the control group.The levels of peripheral blood lymphocytes,natural killer(NK)cells and inflammatory factors were measured and compared between the two groups,and the clinical characteristics and molecular epidemiological characteristics of the patient group were analyzed.Results The number of CD3^(+)T lymphocytes,CD4^(+)T lymphocytes and CD8^(+)T lymphocytes in the patient group were higher than those in the control group,and the number of NK cells and CD19^(+)B lymphocytes in the patient group were lower than those in the control group(P<0.05).The levels of IL-6,IL-8,IL-18,IL-15,TNF-αand IFN-γin the patient group were significantly higher than those in the control group(P<0.05).The main clinical manifestations were fever,eschar or ulcer,and chills,accounting for 100.00%,90.91%and 70.03%respectively.Karp genotype was the main genotype,accounting for 62.63%,followed by Gilliam genotype,accounting for 17.85%.The results of homology analysis showed that the representative strains of Orientia tsutsugamushi(OT)from 297 patients with Tsutsugamushi had high homology with Taiwan km08 and km05 strains.Conclusion Patients with tsutsugamushi disease in Haikou area of Hainan have obvious immune damage,and they are mainly characterized by enhanced humoral immunity,weakened cellular immunity and large release of pro-inflammatory factors.The specificity of the clinical manifestations of patients is limited.Their OT genotypes are diverse but mainly Karp type.The source is also more complicated.