SARS患者在疾病早期CD4^+T细胞减少及其临床意义

The decrease of CD4^+ T cells of patients with SARS in early stage and its clinical significance

目的 :观察SARS患者在疾病早期CD4 + 细胞的改变及其在疾病的发展及治疗选择中的临床意义。方法 :流式细胞仪方法对 5 2例发病 10天内确诊为SARS患者的外周血标本进行T细胞亚群的绝对计数检测并动态观察胸部X光病变的变化及疾病转归。结果 :在 5 2例患者中 ,有 34例CD4 + 细胞绝对数在正常范围内的患者 ,病变范围小、病情呈稳定状态 ,病变吸收快 ,不需要肾上腺糖皮质激素治疗 ;另有 18例患者出现CD4 + 细胞的绝对值低于正常 ,其中有 13例患者病情呈进展状态 ,加用肾上腺糖皮质激素治疗 ,有 5例CD4 + 细胞绝对数轻度减低患者 ,病情处于稳定状态 ,未加用肾上腺糖皮质激素治疗。两组CD4 + 细胞数经统计学分析P =0 0 0 0 ;CD4 + 细胞数与肺内病变程度的Pearson相关性检验结果为r =- 0 737;P =0 0 0 0 ;与糖皮质激素应用的Pearson相关性检验结果为r =- 0 5 73;P =0 0 0 0。结论 :①SARS患者发病早期外周血CD4 + 细胞绝对计数与肺内病变的程度呈良好的负相关 ;②CD4 + 细胞绝对数下降明显者需糖皮质激素治疗。

Objective:To observe the change of CD4 + T cells of SARS patients in early stage of disease and determine its clinical significance on the progress of disease and therapy selection.Methods:Detection the absolute counts of T cell subset from the peripheral blood samples of 52 SARS patients in initial 10 days' duration by Flow cytometry.Serial frontal chest radiographs had done and the progression of disease was observed during the treatment of all patients.Results:The 34 cases among the 52 patients were in normal range of CD4 + cell absolute count.At the same time,their pulmonary lesions were in limited degree and the states of an illness were stabilization and the pulmonary lesions were absorbed quickly.Therefore they reuired the treatment without corticosteroids.The other 18 patients were with low CD4 + cell absolute count, of which 13 cases showed progressive deterioation of radiographic change and were treated with corticosteroids additional.The other 5 cases with the mild low of absolute count of CD4 + cells were also static during the period of observation,and no treatment with coticosteroids.There was statistically significant relation between two groups(P=0 000).The results of Pearson correlate analysis between absolute count of CD4 + cells and pulmonary lesions were r=-0 737;P=0 000;The result between absolute count of CD4 + cells and corticosteroids treatment were r=-0 573;P=0 000.Conclusion:Peripheral blood CD4 + cell absolute counts of SARS patients on early stage of onset were negatively related to the degree of pulmonary lesions.The patients with remarkable decrease of CD4 + cell were in need of treatment with corticosteroids.