外周血CD_(19)^+ B淋巴细胞比例减少患儿病因分析  

Etiological Analysis of Reduction of CD_(19)^+ B Lymphocyte Ratio in Peripheral Blood in Children

作　　者：沈方方[1] 赵晓东[1] 

机构地区：[1]重庆医科大学附属儿童医院肾脏免疫科,重庆400014

出　　处：《实用儿科临床杂志》2010年第21期1628-1630,共3页Journal of Applied Clinical Pediatrics

基　　金：重庆市杰出青年科学基金(CSTC2008BA5040)

摘　　要：目的探讨外周血CD19+B淋巴细胞减少患儿的病因,淋巴细胞亚群变化特点及其临床意义。方法回顾性分析1997年1月-2008年12月本院住院的101例CD19+B淋巴细胞比例≤0.04患儿病例资料,统计其外周血淋巴细胞亚群比例,分析其临床特点。结果 101例患儿中原发性免疫缺陷病(PID)23例(22.8%),非PID 78例(77.2%)。PID中先天性无丙种球蛋白血症11例,其中X连锁无丙种球蛋白血症(XLA)9例;非PID中传染性单核细胞增多症(IM)49例。15例PID CD19+B淋巴细胞比例为0;6例为0.01～0.03;2例为0.04。非PID中2例CD19+B淋巴细胞比例为0;53例为0.01～0.03;23例为0.04。2组患儿CD19+B淋巴细胞降低程度比较差异有统计学意义(P<0.001)。49例IM中48例CD4+淋巴细胞比例降低,1例在正常范围;47例CD8+淋巴细胞比例升高,2例在正常范围;48例CD4+/CD8+比值降低,1例在正常范围。21例CD19+B淋巴细胞比例降低,且总淋巴细胞绝对值减少,其中PID 5例,非PID 16例(10例为噬血细胞淋巴组织增生综合征)。结论在CD19+B淋巴细胞比例降低者中,大部分为非PID,以IM常见。小年龄男童、CD19+B淋巴细胞降低程度重者更应警惕PID,尤其是XLA。同时伴有CD4+淋巴细胞比例降低、CD8+淋巴细胞比例升高、CD4+/CD8+比值降低者,IM的可能性更大。CD+B淋巴细胞比例降低在PID以外的疾病中亦不少见。Objective To explore the etiology of the reduction of CD19^＋B lymphocyte ratio,the characteristics and clinical significance of lymphocyte subpopulation changes.Methods The peripheral blood lymphocytes were classified by flow cytometrics.One hundred and one cases of CD19^＋B lymphocyte ratio less than 0.04 who were hospitalized from Jan.1997 to Dec.2008 were analyzed retrospectively.Summarizing the ratioes of lymphocyte subpopulation and analyzing the characteristics of ratioes between different diseases.Results Among the 101 cases studied,23 cases（22.8%）were primary immunodeficiency disease（PID）,78 cases（77.2%）were non-PID.Among 11 cases of congenital ogammaglobulinemia in PID,9 cases were X-linked agammaglobulinemia（XLA）.Forty-nine cases of non-PID were infectious mononucleosis（IM）.Among the PID,15 cases of CD19^＋B lymphocyte ratio were 0,6 cases were 0.01-0.03,2 cases were 0.04.Among non-PID,2 cases of CD19^＋B lymphocyte ratio were 0,53 cases were 0.01-0.03,23 cases were 0.04.There were statistical significance between the PID and non-PID of CD19^＋B lymphocyte ratio（P0.001）.forty-eight cases of CD4^＋ lymphocyte ratio decreased among 49 cases IM and 1 case in normal range;47 cases of CD8^＋ lymphocyte ratio increased and 2 cases in normal range;48 cases CD4^＋/CD8^＋ ratio decreased and 1 case in normal range.Twenty-one cases of both CD19^＋B lymphocyte ratio and total lymphocyte amount decreased,5 cases were PID,16 cases were non-PID.Among the 16 cases of non-PID,10 cases were hemophagocytic lymphohistiocytosis.Conclusions In the children of the reduction of CD19^＋B lymphocyte ratio,most are non-PID,especially IM.If the children were young,male,CD19^＋B lymphocyte ratio seriously decreased,the paediatrician should be vigilant to PID,especially XLA.If CD4^＋ lymphocyte ratio decreased,CD8^＋ lymphocyte ratio increased accompanied with CD4^＋/CD8^＋ ratio decreased,the most possibility is IM.The reduction of CD19^＋B lymphocyte ratio is not seldom in non-PID.

关 键 词：CD19^+ B淋巴细胞 原发性免疫缺陷病 传染性单核细胞增多症 儿童 

分 类 号：R725.5[医药卫生—儿科]