82例SARS患者T细胞亚群的变化与肺内病变的关系

Relationship between the T-subsets and the pulmonary lesion in 82 SARS patients

目的 观察SAR5患者T淋巴细胞亚群绝对数量的变化与肺内病变情况(病变程度及肺内炎症吸收程度)。方法 用流式细胞仪MultiTEST方法对82例发病14d内的SARS患者外周血标本进行T淋巴细胞亚群绝对数量的动态监测,同时动态观察其与肺内病变程度及炎性病变吸收程度的关系,并分析糖皮质激素对T细胞亚群的影响。结果 ①51例病情较轻患者的外周血T细胞亚群在正常范围内或轻度异常,临床上不需要糖皮质激素治疗;②31例病情呈进展状态的患者均伴有CD4^+细胞减少及肺内病变重,需糖皮质激素治疗。82例患者外周血CD4^+细胞绝对数量与病变程度的相关性为r=-0.684,P=0.000;③31例经糖皮质激素治疗的患者CD4^+细胞及CD8^+细胞绝对计数明显少于糖皮质激素治疗前(P=0.000);④CD8^+细胞数量及与肺内病变吸收程度密切相关(r=-0.816;P=0.000)。结论 ①SARS患者肺内病变程度与CD4^+细胞数量呈负相关;②糖皮质激素治疗后SARS患者外周血CD4^+细胞及CD8^+细胞绝对计数减少;③SARS患者肺内病变的吸收程度与CD8^+细胞数量有良好的负相关性。

Objective To observe the relationship between the absolute amount of T subsets and the pulmonary lesions includeing the degree of pulmonary lesion and the degree of pulmonary opacities improved. Methods The change of the absolute amount of T-cell subsets was observed with the method of MultiTEST on flow cytometry from the samples of 82 SARS patients who were within 14 days after onset of fever. The degree of pulmonary lesion and the degree of lesion adsorption were followed-up by chest radiographs. The affect of corticosteroid on the number of T-subsets was analyzed. Results ① 51 cases with minor symptoms came along with normal or paranormal T-subsets and limited pulmonary lesions, and they needed the no glucocorticoid treatment during the observation; ②31 cases with progress course were with lower CD4^+ cells than normal range, and they went usually with serious pulmonary lesion, therefore they needed the treatment with glucocorticoid. The absolute number of CD4^+ cells in 82 patients was closely related to the degree of pulmonary damage lesion (r=-0.684; P=0.000); ③The absolute number of CD4^+ cells and CD8^+ cells in 31 patients after treatment of glucocorticoid was obviously less than pre-treatment (P=0.000);④The number of CD8^+ cells was closely related to the pulmonary opacities improved after treatment of glucocorticoid (r=-0.816; P=0.000). Conclusion Close negative relationship was found between the degree of pulmonary damage lesion and the absolute amount of CD4^+ cells in peripheral blood of SARS patients. The decrease of absolute amount of CD4^+ cells and CD8^+ cells occurred after the treatment of glucocorticoid in SARS patients. The improvement of pulmonary lesion of SARS patients is closely and negatively related to the number of CD8^+ cells.