新型冠状病毒肺炎患者的胸部CT改变与T淋巴细胞亚群的相关性研究  

Correlation between chest CT changes and T lymphocyte subsets in COVID-19

作　　者：唐光孝 刘雪艳[1] 李春华[1] 王惠秋[1] 舒伟强 赵静 刘羽 吕圣秀 TANG Guangxiao;LIU Xueyan;LI Chunhua;WANG Huiqiu;SHU Weiqiang;ZHAO Jing;LIU Yu;LV Shengxiu(Department of Radiology,Chongqing Public Health Medical Center,Chongqing,400036,China)

机构地区：[1]重庆市公共卫生医疗救治中心医学影像科,重庆400036

出　　处：《中国呼吸与危重监护杂志》2024年第10期691-695,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：重庆市公共卫生医疗救治中心院内项目(2022YNXM03)

摘　　要：目的评价新型冠状病毒(COVID-19)肺炎患者胸部CT病灶变化与T淋巴细胞亚群之间的关系,为评估患者病情变化、预测患者转归和评价疗效提供参考信息。方法收集重庆市公共卫生医疗救治中心2020年1月24日—2020年3月15日间收治的COVID-19确诊患者的临床及影像学资料。根据病灶在CT图像的吸收情况分为三种类型,明显持续吸收型为A组;稳定缓慢吸收为B组;进展后吸收型为C组。根据病灶吸收情况分析其CT变化与T淋巴细胞亚群的关系。结果共纳入患者47例,其中A组18例、B组14例、C组15例。入院首次、疗程中、治疗末次不同时期T淋巴细胞水平,均表现为A组>B组>C组。在病灶吸收时,CD4^(+)T淋巴细胞较高,平均为(544.43±163.34)cell/ul;病灶少量变化和病灶增多时,CD4^(+)T淋巴细胞不同程度下降。在治疗过程中,A、B两组CD4^(+)T淋巴细胞均恢复到正常水平以上,其中A组CD4^(+)T淋巴细胞平均升高134 cell/ul,升高幅度低于B组(192 cell/ul)和C组(149 cell/ul);末次T淋巴细胞均达到正常水平,但A组高于B组和C组(P<0.05)。在复查时,52次病灶吸收时CD4^(+)T淋巴细胞平均(544.43±163.34)cell/ul,31次病灶少量变化时CD4^(+)T淋巴细胞平均(339.06±145.98)cell/ul,16次CT病灶进展时CD4^(+)T淋巴细胞平均(230.50±95.24)cell/ul,三组间有统计学差异(P<0.05)。结论当患者肺部病灶进展增多时,提示其自身免疫功能较差,需加强免疫调节。反之,病程中检测到患者T淋巴细胞水平下降时,要注意病灶进展的风险,及时复查CT观察病灶变化情况。Objective To evaluate the relationship between CT lesion changes in COVID-19 patients and different subgroups of T lymphocytes,providing reference information for assessing patient conditions,predicting outcomes,and evaluating treatment efficacy.Methods Clinical and imaging data of confirmed COVID-19 patients admitted to the Chongqing Public Health Medical Center from January 24 to March 15,2020,were collected.Based on the absorption characteristics of lesions in CT images,patients were categorized into three groups:Group A(obviously continuously absorbed),Group B(stable-slow absorption),and Group C(progressive absorption).The relationship between CT changes and T lymphocyte subgroups was analyzed according to lesion absorption.Results A total of 47 patients were included,with 18 in Group A,14 in Group B,and 15 in Group C.At different stages—admission,during treatment,and at the end of treatment—the levels of T lymphocytes were observed as follows:Group A>Group B>Group C.When lesions were absorbed,the average count of CD4^(+)T lymphocytes was(544.43±163.34)cells/μl;when lesions showed little change or increased,CD4^(+)T lymphocyte levels decreased to varying degrees.During treatment,both Group A and Group B showed CD4^(+)T lymphocyte levels returning to above normal levels,with an average increase of 134 cells/μl in Group A,which was lower than that in Group B(192 cells/μl)and Group C(149 cells/μl).Finally,T lymphocyte levels reached normal in all groups,but Group A levels were higher than those in Groups B and C(P<0.05).Upon follow-up,the average CD4^(+)T lymphocyte count was(544.43±163.34)cells/μl in 52 cases of lesion absorption,(339.06±145.98)cells/μl in 31 cases of minimal change,and(230.50±95.24)cells/μl in 16 cases of lesion progression,with statistically significant differences among the three groups(P<0.05).Conclusions The increase in lung lesions in patients indicates poor immune function,necessitating enhanced immune regulation.Conversely,if a decrease in T lymphocyte levels is detected

关 键 词：新型冠状病毒肺炎 免疫水平 T淋巴细胞 CT CD4^(+) 

分 类 号：R563.1[医药卫生—呼吸系统]