传染性非典型肺炎与常见非典型肺炎T淋巴细胞亚群的差异及意义  

Difference and significance of T-lymphocyte subsets in differential diagnosis between severe acute respiratory syndrome and common atypical pneumonia

作　　者：李明慧[1] 李杏红[2] 李兴旺[1] 马烈[1] 易为[3] 江宇泳[1] 董建平[1] 李蔚丽[1] 

机构地区：[1]北京地坛医院感染内科,100011 [2]北京地坛医院病案统计科,100011 [3]北京地坛医院妇产科,100011

出　　处：《中华实验和临床病毒学杂志》2004年第2期137-141,共5页Chinese Journal of Experimental and Clinical Virology

基　　金：中英合作"SARS免疫病理学"研究课题资助项目 (H0 3 0 2 3 0 10 0 13 0 )

摘　　要：目的　探讨T淋巴细胞亚群在传染性非典型肺炎 (SARS)与常见的非典型肺炎 (非典 )中的差异及意义。方法　定期观察北京地坛医院自 2 0 0 3年 3～ 6月以临床诊断为SARS收治的住院患者 10 0例 ,从初发病开始共观察 3周以上 ,分为SARS组和常见的非典型肺炎组 (非典组 ) ,系统观察两组的CD3+ 、CD4+ 、CD8+ 计数。结果　SARS组病例 6 5例 ,男性 2 6例 ,女性 39例 ,均为普通型 ,5 0例使用甲基泼尼松龙 (激素 )治疗 ;非典组病例 35例 ,男性 2 1例 ,女性 14例 ,2 0例使用激素治疗 ;两组所有病例均临床治愈。SARS组患者T淋巴细胞亚群计数呈先下降后上升的特点 ,病程前 15d内CD3+ 计数均值可降低至 (6 94± 5 6 8)个 μl,CD4+ 计数均值可降低至 (44 1± 35 6 )个 μl,CD8+ 计数均值可降低至 (30 9± 4 6 2 )个 μl ,在病程第 15天以后逐渐回升至正常 ;常见的非典组患者整个病程中CD3+ 、CD4+ 、CD8+ 计数基本在正常范围 ;用激素对非典组患者的T淋巴细胞亚群计数影响不太大 ,用激素的SARS组患者的T淋巴细胞亚群计数的变化规律在病程 15d前与未用激素的同组患者也基本一致 ,但其细胞免疫功能恢复时间推迟 6d左右。结论　SARS患者发病早期CD3+ 、CD4 + 、CD8+ 计数同步降低的特点可作为与常见的非典型肺炎的鉴别诊?Objective To clarify the difference and significance of T-lymphocyte subsets in differential diagnosis between severe acute respiratory syndrome (SARS) and common atypical pneumonia. Methods Totally 100 patients hospitalized in Beijing Ditan Hospital since March to June 2003 with clinical diagnosis of SARS were involved in this study. These patients′ courses of disease were over 3 weeks. These patients were divided into two groups,SARS group and common atypical pneumonia group (non-SARS group).The counts of CD 3 +,CD 4 + and CD 8 + T-lymphocyte of two groups were systematically recorded and analyzed. Results Sixty-five of the patients were confirmed to have common type of SARS, including 26 males and 39 females,50 cases received methylprednisolone treatment. Thirty-five cases had common atypical pneumonia (non-SARS),21 were males while 14 were females,20 cases received methylprednisolone treatment. All the cases of two groups were cured in the end. The SARS patients' T-lymphocyte counts decreased first and then increased. Before 15 days of disease course,mean CD 3 +,CD 4 +,CD 8 + T-lymphocyte counts of SARS patients were decreased apparently (694±568/μl,441±356/μl,309±462/μl). After 15th day of disease course,the counts gradually returned to normal. CD 3 +,CD 4 +,CD 8 + T-lymphocyte counts of non-SARS patients were normal. Compared with patients of the same group who were not treated with glucocorticoids,T-lymphocyte counts of non-SARS patients treated with glucocorticoids had no obvious difference. But glucocorticoids had some effect on SARS patients' recovery of cellular immune function,i.e,it delayed the recovery by about 6 days. Conclusion With or without treatment with glucocorticoids,the lowered CD 3 +,CD 4 +,CD 8 + T-lymphocyte counts in the early stage are of very importmant significance in differential diagnosis between severe acute respiratory syndrome and common atypical pneumonia.

关 键 词：传染性非典型肺炎 T淋巴细胞亚群 严重急性呼吸综合征 SARS 鉴别诊断 

分 类 号：R511.9[医药卫生—内科学]