机化性肺炎患者T淋巴细胞亚群分析的临床意义

Clinical value of T lymphocyte subsets analysis of patients with organizing pneumonia

目的检测机化性肺炎患者支气管肺泡灌洗液(BALF)及外周血中T淋巴细胞亚群,探讨其在机化性肺炎诊断中的价值。方法选择2013—2019年武警特色医学中心收治的45例机化性肺炎患者及同期30名健康体检者作为研究对象,分别纳入观察组和对照组。使用流式细胞术检测所有研究对象BALF及外周血中T细胞亚群(包括CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)),比较两组上述指标差异。绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),考察T淋巴细胞亚群对机化性肺炎的诊断效能。结果观察组BALF和外周血中CD3^(+)CD4^(+)、CD4^(+)/CD8^(+)比值均明显低于对照组,CD3^(+)CD8^(+)明显高于对照组[BALF中:CD3^(+)CD4^(+):(29.86±1.44)%比(36.17±0.87)%,CD4^(+)/CD8^(+):0.670±0.053比1.242±0.066,CD3^(+)CD8^(+):(51.69±2.02)%比(30.55±1.22)%;外周血中:CD3^(+)CD4^(+):(29.23±1.49)%比(35.17±1.38)%,CD4^(+)/CD8^(+):0.810±0.067比1.279±0.104,CD3^(+)CD8^(+):(36.64±1.76)%比(30.31±1.03)%;均P<0.05];观察组BALF中CD3^(+)和CD3^(+)CD8^(+)明显高于PB[观察组CD3^(+):(84.61±1.54)%比(71.91±1.41)%,CD3^(+)CD8^(+):(51.69±2.02)%比(36.64±1.76)%,均P<0.05]。BALF中T细胞亚群诊断机化性肺炎的AUC为0.892[95%可信区间(95%CI)为0.808~0.963],明显高于外周血(AUC为0.747,95%CI为0.628~0.866),差异有统计学意义(P<0.05)。结论BALF及外周血中T淋巴细胞亚群分析对诊断机化性肺炎有一定意义。

Objective To detect T lymphocyte subsets in bronchoalveolar lavage fluid(BALF)and peripheral blood(PB)of patients with organized pneumonia and explore the value in diagnosis of organized pneumonia.Methods The 45 patients with organized pneumonia admitted to Characteristic Medical Center of PAP from 2013 to 2019 and 30 healthy individuals in the same period were selected as research subjects,and were included in observation group and control group,respectively.Flow cytometry was used to detect T lymphocyte subsets(including CD3^(+),CD3^(+)CD4^(+),CD3^(+)CD8^(+))in BALF and PB of all study subjects,and the differences in above indicators were compared between the two groups.The receiver operator characteristic(ROC)curve was drawn and the area under ROC curve(AUC)was calculated to investigate the diagnostic efficacy of T lymphocyte subsets detection on organized pneumonia.Results The levels of CD3^(+)CD4^(+)and CD4^(+)/CD8^(+)ratio in BALF and PB of observation group were lower than those of control group,and CD3^(+)CD8^(+)was higher than that in control group[in BALF:CD3^(+)CD4^(+):(29.86±1.44)%vs.(36.17±0.87)%,CD4^(+)/CD8^(+):0.670±0.053 vs.1.242±0.066,CD3^(+)CD8^(+):(51.69±2.02)%vs.(30.55±1.22)%;in PB:CD3^(+)CD4^(+):(29.23±1.49)%vs.(35.17±1.38)%,CD4^(+)/CD8^(+):0.810±0.067 vs.1.279±0.104,CD3^(+)CD8^(+):(36.64±1.76)%vs.(30.31±1.03)%,all P<0.05].The levels of CD3^(+)and CD3^(+)CD8^(+)in observation group were higher in BALF than those in PB[observation group CD3^(+):(84.61±1.54)%vs.(71.91±1.41)%,CD3^(+)CD8^(+):(51.69±2.02)%vs.(36.64±1.76)%,all P<0.05].The AUC of T cell subsets in BALF for diagnosis of organized pneumonia was 0.892[95%confidence interval(95%CI)was 0.808-0.963],which was higher than that of PB(AUC was 0.747,95%CI was 0.628-0.866),with significant difference(P<0.05).Conclusion Analysis of T lymphocyte subsets in BALF and PB is helpful for clinic diagnosis and observation of cryptogenic organizing pneumonia.