重症甲型H1N1流感患者外周血T淋巴细胞亚群变化的临床意义探讨  

Clinical Significance of Peripheral Blood T-lymphocyte Subsets Changes in Pandemic Influenza(H1N1) Patients

作　　者：陈颖[1] 王军[1] 温华[1] 代兵[1] 孙龙凤[1] 谭伟[1] 康健[1] 赵洪文[1] 

机构地区：[1]中国医科大学附属第一医院呼吸内科,沈阳110001

出　　处：《中国医科大学学报》2011年第2期140-143,共4页Journal of China Medical University

基　　金：辽宁省医学高峰建设工程重点科研项目(200922)

摘　　要：目的探讨甲型H1N1流感（甲流）患者外周血T淋巴细胞亚群的变化及临床意义。方法采用流式细胞仪对70例甲流患者,19例普通流感患者,31例健康体检者的外周血T淋巴细胞亚群进行检测。70例甲流患者中,男51例,女19例,年龄19~66岁。其中重症24例,危重症46例（死亡8例）。结果普通流感患者外周血T淋巴细胞亚群与健康对照组无差别,但甲流患者外周血CD3、CD4、CD8 T淋巴数均明显低于健康对照组和普通流感组（P均〈0.05）;危重症甲流患者外周血CD3、CD4、CD8T淋巴数均分别明显低于重症甲流患者（P均〈0.01）;死亡患者外周血CD3、CD4、CD8 T淋巴数均明显低于存活患者（P均〈0.01）,而且死亡患者CD3和CD4均小于正常低值;各组间CD4/CD8变化无显著差别;甲流患者和健康对照者血中免疫球蛋白水平无差别。结论甲型H1N1流感病毒可能损伤细胞免疫,尤其是T细胞免疫,但未损伤体液免疫。外周血T淋巴细胞亚群数量减少可能是病情严重性和疾病转归及预后的一个重要指标,而且早期检测对甲流与普通流感的鉴别可能有重要意义。Objective To investigate the change of peripheral blood T-lymphocyte subsets in pandemic influenza（H1N1） and its clinical significance.Methods The subsets of peripheral blood T-lymphocyte in 70 patients with pandemic influenza（H1N1）,19 patients with seasonal influenza and 31 normal subjects were detected by flow cytometry.The patients with pandemic influenza（H1N1） comprised of 51 male and 19 female aged 19 to 66 years,including 24 severe cases and 46 critical cases.Results There was no significant difference in the numbers of peripheral blood T-lymphocyte subsets between the patients with seasonal influenza and normal subjects.However,the numbers of CD3,CD4 and CD8 lymphocytes significantly decreased in patients with pandemic influenza（H1N1） compared with those in seasonal influenza and normal subjects（P 〈 0.05）,especially in critical patients（P 〈 0.01）.The counts in non-survivors decreased significantly compared with those in survivors（P 〈 0.01）,and both the counts of CD4 and CD8 in non-survivors were less than the normal lower limit.There was no significant change in CD4/CD8 ratio among the three groups.IgA,IgM and IgG were not distinctive between the pandemic influenza（H1N1） patients and the normal subjects.Conclusion Pandemic influenza（H1N1） might impair the cellular immunity,especially T-lymphocyte immunity,but not humoral immunity.The subsets of peripheral blood T lymphocyte might be an important index for the severity and prognosis of the disease.Early detection on them might have important significance for distinguishing pandemic influenza（H1N1） from seasonal influenza.

关 键 词：甲型H1N1流感 T淋巴细胞亚群 细胞免疫 

分 类 号：R563.8[医药卫生—呼吸系统]