人感染H7N9禽流感肺炎CT表现与病毒载量及CD4^+T淋巴细胞的相关性  

The correlation of CT manifestation,viral load and CD4^+T lymphocyts in patients with H7N9 avian influenza pneumonia

作　　者：黄湘荣[1] 黄华[1] 陆普选[1] 曾政[1] 陈小芳[1] 周伯平[2] 刘映霞[2] 袁静[2] 李国保[2] 邓群益[2] 

机构地区：[1]深圳市第三人民医院放射科,广东518112 [2]深圳市第三人民医院感染科,广东518112

出　　处：《放射学实践》2014年第7期751-755,共5页Radiologic Practice

基　　金：深圳市知识创新计划重点项目(JCYJ20130401164750006);广东省医学科研基金(A2011543)

摘　　要：目的:探讨人感染H7N9禽流感肺炎CT扫描半定量评分与病毒载量、CD4+T淋巴细胞数量的动态变化及相关性。方法:搜集2013年12月-2014年2月本院确诊的9例人感染H7N9禽流感患者的临床资料,所有患者入院后行每日病毒M片段Ct值测定、血常规及T淋巴细胞亚群检测、定期胸部CT扫描,根据CT表现进行半定量评分,观察三者的变化,并进行统计学分析。结果:病程早期(≤4d):明确诊断2例,病毒M片段Ct值分别为34.28和30.48。3例患者病程早期共行4次胸部CT扫描和T淋巴细胞亚群检测,CT表现半定量评分平均为3.68±1.25,CD4+T淋巴细胞数平均为33.03±3.34。病程进展期(5d≤d≤10d):病程的第5~7天病毒M片段Ct值达到低值28.72±3.88,8~10d病毒M片段Ct值增加为30.57±3.07,但两者差异无统计学意义(t=0.747,P>0.05)。肺炎CT表现评分和CD4+T淋巴细胞变化略滞后于病毒载量变化,于8~10dCT表现评分达到峰值(12.94±6.10),与早期相比,CT评分均值增加50%,而CD4+T淋巴细胞数降低为24.39±5.15。病程恢复期(≥11d),此期病毒载量下降或转阴,CD4+T淋巴细胞数恢复正常,肺部病灶吸收减少。结论:在病变进展期,人感染H7N9禽流感病毒载量、CD4+T淋巴细胞与胸部CT表现半定量评分存在一定相关性。监测三者的变化趋势,对临床疗效评估及预后判断具有重要意义。Objective：To investigate the dynamic change and correlation of CT manifestations with semi-quantitativescore,viral load and CD4^＋Tlymphocyte in patients with H7N9 avian influenza pneumonia.Methods：The clinical and imagingmaterials of 9 patients having H7N9 avian influenza pneumonia in the time period of 2013-12 to 2014-02 were collected.The viral Mfragment Ct values and blood routine,T lymphocyte subtype were examined every day after admission,chest CT examination was performed regularly.The changes of CT semi-quantitative score,viral load and CD4 ^＋ T lymphocytswere studied and analyzed statistically.Results：Two patients in early phase were diagnosed on the 3thd and 4thd respectively（≤4d）,and the viral Mfragment Ct value was 34.28,30.48 respectively.3 patients had totally 4 times of chestCT and Tlymphocyte subtype examination.The averages of CT semi-quantitative score and CD4^＋Tlymphocyte were3.68±1.25,33.03 %±3.34% respectively.During the progressive period （5d≤d≤10d）,the viral Mfragment Ct valuereaches its lowest 5-7d after onset（28.72 ±3 .88）,and increased slightly （30.57 ±3 .07）during 8-10d,there was no statisticaldifference between 5-7d and 8-10d（t=0.747,P＆gt;0.05 ）.The score changes of CT manifestation and CD4 ^＋ Tlymphocyte lagged behind the viral Mfragment Ct value slightly,the score change of CT reached its peak （12 .94±6.10）on8-10d.Compared with that of early phase,the average CT score value increased 50%,while CD4 ^＋ Tlymphocyte decreasesto 24.39 ±5.15 .In the recovery phase（≥11d）,the viral load decreased or turned to negative,CD4^＋T lymphocyts becamenormal,and pulmonary lesions reduced or absorbed.Conclusion：During the progressive phase of H7N9 avian influenza pneumonia in human beings,there was a certain correlation between the semi-quantitative score of CT manifestations,viral loadand CD4^＋Tlymphocyte.Monitoring the change trends of the three plays an important role in the evaluation of clinical treatmentefficacy and prognosis judgem

关 键 词：禽流感 病毒载量 T淋巴细胞亚群 体层摄影术 X线计算机 

分 类 号：R816.41[医药卫生—放射医学] R563.1[医药卫生—临床医学]