慢性活动性EBV感染患者外周血淋巴细胞表达水平及预后危险因素分析

Expression of peripheral blood lymphocytes and prognostic risk factors in patients with chronic active EBV infection

目的探讨慢性活动性EB病毒感染(CAEBV)患者外周血淋巴细胞表达水平及预后危险因素分析。方法选取2017年1月—2021年1月我院收治的64例CAEBV患者为CAEBV组,同期64例传染性单核细胞增多症(IM)患者为IM组,64例体检健康人群为对照组。比较3组白细胞计数、淋巴细胞计数水平、外周血NK细胞、B细胞水平以及CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)CD28^(+)、CD8^(+)CD28^(+)、CD4^(+)CD25^(+)、DR^(+)CD8^(+)、CD38^(+)CD8^(+)、CD4^(+)和CD8^(+)初始T细胞、记忆T细胞亚群水平。对CAEBV患者进行随访,根据患者结局分为存活组(n=49)和死亡组(n=15),收集两组一般资料,比较两组上述各指标水平,并对两组预后单因素分析具有统计学差异指标进一步进行Logistic回归分析。结果与对照组比较,IM组白细胞计数、淋巴细胞计数、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)CD25^(+)、DR^(+)CD8^(+)、CD38^(+)CD8^(+)、效应记忆CD4^(+)CD62L-CD45RO^(+)、效应记忆CD8^(+)CD62L-CD45RO^(+)更高,而NK细胞、B细胞水平、CD4^(+)CD28^(+)、CD8^(+)CD28^(+)、初始CD4^(+)CD62L^(+)CD45RA^(+)、初始CD8^(+)CD62L^(+)CD45RA^(+)水平更低(均P<0.05);与对照组比较,CAEBV组白细胞计数、淋巴细胞计数、CD3^(+)、CD4^(+)、CD8^(+)、NK细胞、B细胞水平、CD4^(+)CD28^(+)、CD8^(+)CD28^(+)、初始CD4^(+)CD62L^(+)CD45RA^(+)、初始CD8^(+)CD62L^(+)CD45RA^(+)水平更低,CD4^(+)CD25^(+)、DR^(+)CD8^(+)、CD38^(+)CD8^(+)、效应记忆CD4^(+)CD62L-CD45RO^(+)、效应记忆CD8^(+)CD62L-CD45RO^(+)更高(均P<0.05)。IM组及CAEBV组各指标水平比较均具有统计学差异(均P<0.05)。存活组与死亡组在EBV DNA拷贝数、血小板计数、总胆红素、AST、白蛋白、血清铁蛋白、CD4^(+)CD28^(+)、CD38^(+)CD8^(+)、初始CD4^(+)CD62L^(+)CD45RA^(+)、初始CD8^(+)CD62L^(+)CD45RA^(+)水平上比较具有统计学差异(均P<0.05)。多因素Logistic回归分析结果显示,EBV DNA>10^(5)拷贝/mL、血小板计数<50×10^(12)/L、白蛋白<30 g/L以及血清铁蛋白>5000μg/L是CAEBV患者死亡的独立危险因素。结论CAEBV患者存在淋巴细胞亚群失衡及免疫功能紊乱,EBV DNA>10^(5)拷贝/mL、血小板计数<50×10^(12)/L、白蛋白<30 g/L以及血清铁蛋白>5000μg/L是影响患者死亡的危险因素(P<0.05),需及时采取控制措施。

Objective To investigate the expression level of peripheral blood lymphocytes and prognostic risk factors in patients with chronic active EBV(CAEBV)infection.Methods 64 patients with CAEBV in our hospital were selected as the research object(CAEBV group),64 patients with infectious mononucleosis were selected as the IM group,and 64 healthy people were selected as the control group.The levels of leukocyte count,lymphocyte count,peripheral blood NK cells,B cells,CD3^(+),CD4^(+),CD8^(+),CD4^(+)CD28^(+),CD8^(+)CD28^(+),CD4^(+)CD25^(+),DR^(+)CD8^(+),CD38^(+)CD8^(+),CD4^(+)and CD8^(+)initial T cells and memory T cell subsets were compared.The patients with CAEBV were followed up and divided into survival group and death group according to the outcome.The general data of the two groups were collected,and the above indexes of the two groups were compared.The indexes with statistical difference in univariate analysis of prognosis between the two groups were further analyzed by logistic regression.Results Compared with the control group,the leukocyte count,lymphocyte count,CD3^(+),CD4^(+),CD8^(+),CD4^(+)CD25^(+),DR^(+)CD8^(+),CD38^(+)CD8^(+),effect memory CD4^(+)CD62L-CD45RO^(+),effect memory CD8^(+)CD62L-CD45RO^(+)^(+)in IM group were higher,while the levels of NK cells,B cells,CD4^(+)CD28^(+)CD8^(+)CD28^(+),initial CD4^(+)CD62L^(+)CD45RA^(+)and initial CD8^(+)CD62L^(+)CD45RA^(+)were lower(all P<0.05).Compared with the control group,the levels of leukocyte count,lymphocyte count,CD3^(+),CD4^(+),CD8^(+),NK cells,B cells,CD4^(+)CD28^(+),CD8^(+)CD28^(+),initial CD4^(+)CD62L^(+)CD45RA^(+),initial CD8^(+)CD62L^(+)CD45RA^(+)in CAEBV group were lower,and the levels of CD4^(+)CD25^(+),DR^(+)CD8^(+),CD38^(+)CD8^(+),effector memory CD4^(+)CD62L-CD45RO^(+),effector memory CD8^(+)CD62L-CD45RO^(+)were higher(all P<0.05).There was significant difference between IM group and CAEBV group(all P<0.05).There were significant differences in EBV DNA copy number,platelet count,total bilirubin,AST,albumin,serum ferritin,CD4^(+)CD62L-CD45RO^(+)CD28^(+)CD62L-CD45RO^(+),CD38^(+)CD62L-CD45RO^(+)CD8^(+)CD62L-CD45RO^(+),initial CD4^(+)CD62L-CD45RO^(+)CD62L^(+)CD62L-CD45RO^(+)CD45RA^(+)CD62L-CD45RO^(+),initial CD8^(+)CD62L-CD45RO^(+)CD62L^(+)CD62L-CD45RO^(+)CD45RA^(+)CD62L-CD45RO^(+)between the survival group and the death group(P<0.05).Multivariate logistic regression analysis showed that EBV DNA>10^(5)copies/mL and platelet count<50×10^(12)/L,albumin<30 g/L and serum ferritin>5000μg/L was an independent risk factor for death in patients with CAEBV.Conclusion There are imbalance of lymphocyte subsets and immune dysfunction in CAEBV patients.EBV DNA>105 copies/ml and platelet count<50×10^(12)/L,albumin<30 g/L and serum ferritin>5000μg/L are risk factors affecting the death of patients(P<0.05),and control measures should be taken in time.