静脉血栓栓塞症与冠状动脉粥样硬化患者T细胞免疫功能变化的比较分析  

Comparison of immune function of T cells in patients with venous thromboembolism or coronary artery atherosclerosis

作　　者：周琳[1] 王乐民[1] 蒋金法[1] 徐文俊[1] 许嘉鸿[1] 宋浩明[1] 

机构地区：[1]同济大学附属同济医院心内科,上海200065

出　　处：《临床心血管病杂志》2015年第5期528-531,共4页Journal of Clinical Cardiology

基　　金：上海市卫生局课题(No:2010108);上海市科委重点项目课题(No:11411951400);上海市卫生局青年课题(No:2009Y071)

摘　　要：目的:研究静脉血栓栓塞症(VTE)患者、冠心病(CHD)患者与正常对照组之间T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)水平变化以及超敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP)的差异。方法:入选247名研究对象,其中正常对照组82例,VTE组51例,CHD组114例。分别检测T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、hs-CRP、空腹血糖(FBG)以及血脂系列。结果:VTE组与对照组相比,CD3+T淋巴细胞显著降低(P<0.05),CD4+T淋巴细胞没有显著性差异(P>0.05),CD8+T淋巴细胞显著降低(P<0.01),CD4/CD8比例升高(P<0.05)。CHD组与对照组相比,CD8+T显著降低(P<0.01),CD4/CD8升高(P<0.05)。VTE组与CHD组相比CD3+、CD4+、CD8+、CD4+/CD8+无显著性差异。观察3组间CD值过低、正常及过高各占比例,并行χ2值检验,结果发现VTE组、CHD组与对照组相比有统计学意义,主要表现在CD3+和CD8+T淋巴细胞下降的比例升高;CD4+/CD8+升高的比例显著增多,而CHD组与VTE组没有明显区别。VTE组和CHD组hs-CRP均高于对照组,而VTE组和CHD组间差异没有统计学意义。结论:VTE组与CHD组均存在T淋巴细胞免疫功能紊乱,表现为CD3+和CD8+T淋巴细胞减少,CD4+T淋巴细胞没有明显变化,CD4/CD8比值显著升高。提示VTE和CHD患者整体的T细胞识别抗原和转导活化信号的功能下降,同时T细胞直接杀伤病毒微生物的功能显著下降。同时炎性因子hs-CRP在VTE组及CHD组均明显升高,提示相同的炎症免疫机制参与了静脉血栓与动脉血栓的发生发展。Objective： Recent studies showed the major risk factors of arterial thrombotic diseases were closely related to venous thrombosis. This study aimed to investigate the expressions of CD3, CD4 and CD8 in T lympho- cytes, CD4/CD8 ratio and high-sensitivity C-reactive protein （hs-CRP） in patients with VTE, coronary artery ath- erosclerosis （CAA） and healthy subjects. Method：A total of 82 healthy subjects, 51 VTE patients and 114 CAA patients were recruited, and the expressions of CD3, CD4 and CD8 in T lymphocytes and CD4/CD8 ratio were de- termined. The serum hs-CRP was also measured. Result：When compared with healthy subiects, VTE patients had significantly reduced CD3 expression （P~ 0.05）, comparable CD4 expression （ P ~ 0.05）, significantly reduced CD8 （P%0.01） and increased CD4/CD8 ratio （P%0.05）. CHD patients had significantly reduced CD8 （P~ 0.01） and increased CD4/CD8 ratio （P%0.05）~ However, VTE patients had comparable expressions of CD3, CD4 and CD8 and CD4/CD8 ratio to CAA patients. In addition, results showed, among patients with VTE or CAA, the proportion of patients with reduced CD3＋ and CD8＋ T lymphocytes or increased CD4＋/CD8＋ ratio in- creased significantly when compared with healthy subjects. In addition, hs-CRP in VTE group and CAA group was significantly higher than that in healthy subjects. Conclusion： The antigen recognition and signal transduction activation of T cells reduce significantly in patients with VTE or CAA, and the killing effect of T cells on patho- gens including virus is also significantly compromised. In addition, inflammatory and immune mechanisms are involved the occurrence and development of venous and arterial thrombosis.

关 键 词：免疫功能 T淋巴细胞 静脉血栓栓塞症 冠状动脉粥样硬化 

分 类 号：R543.5[医药卫生—心血管疾病]