系统性硬化症并间质性肺疾病与外周血 T细胞亚群的相关性研究

Correlation between peripheral blood T cell subsets and systemic sclerosis associated interstitial lung disease

目的探讨系统性硬化症(SSc)并间质性肺疾病(ILD)与外周血T细胞亚群的相关性。方法选取2018年1月至2020年12月期间海南医学院第一附属医院风湿免疫科收治的40例SSc患者为研究对象,所有患者均给予外周血T细胞亚群水平检测,并采用高分辨率CT扫描对SSc患者进行ILD分级。根据SSc患者是否合并ILD分为SSc-ILD组和SSc-Non-ILD组,比较两组患者外周血CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平。采用Pearson检验分析SSc患者ILD分级与外周血T细胞亚群水平的相关性,绘制受试者工作特性(ROC)曲线分析外周血T细胞亚群水平对SSc-ILD的最佳截断值、敏感度、特异度。结果SSc-ILD组和SSc-Non-ILD组患者的CD8^(+)[(33.64±7.28)vs(29.56±6.52)]水平比较,SSc-ILD组明显高于SSc-Non-ILD组,CD3^(+)[(66.73±11.32)vs(70.51±10.84)]、CD4^(+)/CD8^(+)[(1.13±0.25)vs(1.58±0.35)]水平比较,SSc-ILD组明显低于SSc-Non-ILD组,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,SSc患者ILD分级与CD3^(+)、CD4^(+)/CD8^(+)呈负相关(r=-0.755、-0.659,P<0.05),与CD8^(+)呈正相关性(r=0.845,P<0.05);ROC曲线分析结果显示,CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平对SSc-ILD的曲线下面积(AUC)分别为0.745、0.797、0.667,最佳截断值分别为67.65、32.70、1.29,敏感度分别为79.2%、83.8%、75.0%,特异度分别为68.4%、71.1%、73.7%。结论SSc患者免疫功能紊乱与其并发ILD密切相关,外周血CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平改变对SSc-ILD病情评估和临床诊断具有重要的价值。

Objective To explore the correlation between peripheral blood T cell subsets and systemic sclerosis(SSc)associated interstitial lung disease(ILD).Methods From January 2018 to December 2020,40 patients with SSc admitted to the Department of Nephrology and Rheumatology,the First Affiliated Hospital of Hainan Medical College were selected as the research objects.All patients were given peripheral blood T cell subsets level detection,and high-resolution CT scanning was used to grade the ILD of SSc patients.The patients with SSc were divided into SSc-ILD group and SSc-Non-ILD group according to whether they were combined with ILD.The levels of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in peripheral blood of the two groups were compared.Pearson test was used to analyze the correlation between ILD grading and peripheral blood T cell subsets in SSc patients.Receiver operating characteristic(ROC)curve was drawn to analyze the optimal cutoff values,sensitivity and specificity of peripheral blood T cell subsets to SSc-ILD.Results The level of CD8^(+)in SSc-ILD group was(33.64±7.28)versus(29.56±6.52)in SSc-Non-ILD group,and the levels of CD3^(+),CD4^(+)/CD8^(+)were(66.73±11.32)and(1.13±0.25),respectively,which were significant lower than corresponding(70.51±10.84)and(1.58±0.35)in SSc-Non-ILD group(P<0.05).Pearson correlation test showed that ILD grade of SSc patients was negatively correlated with CD3^(+),CD4^(+)/CD8^(+)(r=-0.755,-0.659,P<0.05),and positively correlated with CD8^(+)(r=0.845,P<0.05).ROC curve analysis showed that areas under curve(AUC)of CD3^(+),CD8^(+)and CD4^(+)/CD8^(+)levels to SSc-ILD were 0.745,0.797 and 0.667,respectively.The optimal cutoff values were 67.65,32.70 and 1.29,respectively.The sensitivity was 79.2%,83.8%,and 75.0%,and the specificity was 68.4%,71.1%,and 73.7%,respectively.Conclusion Immune dysfunction is closely related to ILD in SSc patients,and the changes of CD3^(+),CD8^(+),and CD4^(+)/CD8^(+)levels in peripheral blood are of great value in the assessment and clinical diagnosis of SSc-ILD.