T淋巴细胞亚群水平对IPF诊断及预后的评估价值

Value of T lymphocyte subsets in the diagnosis and prognosis with IPF

目的分析特发性肺间质纤维化(IPF)患者T淋巴细胞亚群变化及其与预后的关系。方法选取60例IPF患者作为IPF组,根据随访结果分为预后不良组和预后良好组,另选取30例健康体检者作为对照组。比较各组外周血T淋巴细胞亚群水平,分析IPF患者T淋巴细胞亚群水平与高分辨率计算机断层扫描(HRCT)纤维化评分、肺功能及预后的关系。结果治疗前,IPF组患者外周血CD8^(+)水平高于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平低于对照组(P<0.05)。IPF组患者入院时CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平与肺功能指标呈正相关,与HRCT评分呈负相关(P<0.05);CD8^(+)水平与肺功能指标呈负相关,与HRCT评分呈正相关(P<0.05)。预后良好组治疗后外周血CD8^(+)水平低于预后不良组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于预后不良组(P<0.05);IPF患者治疗后外周血CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)ROC曲线下面积分别为0.732、0.744、0.756、0.796(P<0.05)。结论T淋巴细胞亚群水平与IPF患者的预后密切相关,CD8^(+)高水平,CD3^(+)、CD4^(+)低水平可提示其预后不良。

Aim To investigate the value of T lymphocyte subsets in the diagnosis and prognosis with idiopathic pulmonary interstitial fibrosis(IPF).Methods:Sity patients with IPF were selected as the IPF group,and divided into poor prognosis group and good prognosis group according to the follow-up results.In addition,30 healthy subjects were selected as the control group.The levels of peripheral blood T lymphocyte subsets in each group were compared,and the relationship between the levels of T lymphocyte subsets and fibrosis score,pulmonary function and prognosis of patients with IPF were analyzed by high-resolution computed tomography(HRCT).Results:The levels of CD8^(+) cells in IPF group were higher than those in the control group,while the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+) cells in IPF group were lower than those in the control group(P<0.05).The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+) cells were positively correlated with pulmonary function index and negatively correlated with HRCT score in the IPF group(P<0.05),the level of CD8^(+) cells was negatively correlated with pulmonary function index,and positively correlated with HRCT score(P<0.05).The level of peripheral blood CD8^(+) cells in good prognosis group was lower than that in the poor prognosis group after treatment,while the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+) cells were higher(P<0.05).The areas under the ROC curve of peripheral blood CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+) in patients with IPF were 0.732,0.744,0.756 and 0.796 respectively(P<0.05).Conclusion The level of T lymphocyte subsets is closely related to the prognosis of IPF,the high expression of CD8^(+) and the low expression of CD3^(+) and CD4^(+) may indicate poor prognosis.