淋巴细胞亚群及炎症因子对新型冠状病毒肺炎患者的临床价值研究

Clinical Values of Lymphocyte Subsets and Inflammatory Factors in Patients with Novel Coronavirus Pneumonia

目的分析新型冠状病毒肺炎(COVID-19)患者外周血淋巴细胞亚群及炎症因子的变化特征,为临床对COVID-19早期预警和病情判断提供数据支持。方法选取2022年12月10日至12月31日中国中医科学院望京医院收治的81例COVID-19确诊患者作为研究对象,按疾病严重程度分为中型、重型和危重型组。分析3组患者成熟T淋巴细胞(CD3^(+))、辅助/诱导性T细胞(CD4^(+))及细胞毒性/抑制性T细胞(CD8^(+))、B淋巴细胞、NK细胞、PCT、CRP、IL-6、血清铁蛋白(SF)的表达水平差异。采用秩和检验评价以上指标。同时,将重型和危重型合并为重症型组,应用受试者工作曲线(ROC)评价以上指标在中型和重症型患者间的诊断价值。结果本研究共收集81例新冠肺炎患者,其中危重型12例(男女比例:3∶1)、重型26例(男女比例:17∶9)、中型43例(男女比例:23∶20);平均年龄81.5、77.5和70.3岁(P<0.01)。淋巴细胞亚群中CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、B淋巴细胞绝对值随着病情加重呈降低趋势(P<0.05)。炎症因子结果显示:PCT、CRP、IL-6水平在中型、重型、危重型间呈升高趋势(P<0.05)。ROC曲线分析各个指标对COVID-19重症型的诊断价值显示:CRP曲线下面积0.6928,最佳临界值48.13mg/L,灵敏度0.474,特异性0.837;铁蛋白曲线下面积0.7795,最佳临界值398.9ng/mL,灵敏度0.889,特异性0.545;B细胞、CD3^(+)T、CD4^(+)T细胞曲线下面积分别为0.677、0.652、0.645。结论CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞、B淋巴细胞、PCT、CRP、IL-6、SF水平对COVID-19的严重程度有一定的指示作用。

Objective To analyze changes of peripheral blood lymphocyte subsets and inflammatory factors in patients with COVID-19,and to provide data-driven supports for the clinical early warning and disease judgment of COVID-19.Methods A total of 81 confirmed COVID-19 patients admitted to Wang Jing Hospital of CACMS(China Academy of Chinese Medical Sciences)from December,10 to December,31,2022 were selected as study subjects,and these patients were divided into the medium group,severe group and critical group according to the severity of the disease.The differences in the expression levels of mature T lymphocytes(CD3^(+)),CD4^(+)and CD8^(+)T lymphocytes,B lymphocytes,NK cells,PCT,CRP,IL-6 and SF among these three groups were analyzed.The rank sum test was used to evaluate values of the above indicators.Furthermore,the severe group and critical group were combined into the severe disease group,and receiver operating characteristic curve(ROC)was drawn to evaluate the diagnostic value of the above indicators in patients within the medium group and severe disease group.Results A total of 81 patients with COVID-19 were collected in this study,including 12 patients as the critical group(male/female ratio:3/1),26 patients as the severe group(male/female ratio:17/9)and 43 patients as the medium group(male/female ratio:23/20),with average ages of 81.5,77.5 and 70.3 years old(P<0.01),respectively.In lymphocyte subsets,the absolute values of CD3^(+)T cells,CD4^(+)Tcells,CD8^(+)Tcells and B lymphocytes decreased with the progression of disease(P<0.05).The results of inflammatory indicators showed that PCT,CRP and IL-6 levels were increased among medium,severe and critical patients(P<0.05).The diagnostic value of various indexes of ROC curve analysis for severe COVID-19 showed that the area under the CRP curve was 0.6928,while the optimal cut-off value was 48.13mg/L,the sensitivity was 0.474,and the specificity was 0.837.The area under the SF curve was 0.7795,while the optimal cut-off value was 398.9ng/mL,the sensitivity was 0.889,and the specificity was 0.545;The areas under the curves of B cells,CD3^(+)T and CD4^(+)T cells were 0.677,0.652 and 0.645,respectively.Conclusion CD3^(+),CD4^(+),CD8^(+)T lymphocytes,B lymphocytes,PCT,CRP,IL-6 and SF have potential prediction values of COVID-19 severity.