肺动脉血栓栓塞症患者的免疫学变化及在诊疗中的作用  

The changes of immune function among patients with pulmonary thromboembolism and the role in diagnosis and treatment

作　　者：虞宇楠 周琳[2] 沈玉芹[2] 严文文[2] 曾金美 龚朱[2] 王乐民[2] 宋浩明[2] 

机构地区：[1]同济大学医学院,上海200065 [2]同济大学附属同济医院心内科

出　　处：《临床心血管病杂志》2016年第9期943-947,共5页Journal of Clinical Cardiology

基　　金：国家自然科学基金面上项目(No:81370422);国家自然科学基金青年科学基金(No:81400347);上海市科委重点项目课题(No:11411951400)

摘　　要：目的:明确免疫功能在肺动脉血栓栓塞症(pulmonary thromboembolism,PE)中的作用及为PE的防治提供新的诊疗思路。方法:选取在同济大学附属同济医院住院的PE患者70例(PE组),另选对照组20例。所有入选者均行下列检测:NYHA心功能分级,血生化指标,心电图,X线胸片,超声心动图,肺通气/灌注扫描或肺血管CT等;并通过流式细胞仪测定免疫细胞的表面分化抗原、补体及细胞因子等,同时随访各项指标变化。结果:PE组CD3、CD8显著降低(P<0.05),CD4/CD8比值显著升高(P<0.05),随访1或3个月和6个月时的D-二聚体和NYHA心功能与基础水平相比差异有统计学意义(均P<0.05);同时随访6个月时的CD3、CD8和CD4/CD8比值与基础值相比差异有统计学意义(P<0.05)。与对照组比较,PE组总补体、C3和C4、白细胞介素-6(interleukin-6,IL-6)均明显上升,差异有统计学意义(均P<0.05)。随访发现仅IL-6出现显著变化(P<0.05),CD3水平与NYHA心功能相关(P<0.05),CD8水平和CD4/CD8比值与NYHA心功能、肺血管CTA、肌钙蛋白和pro-BNP相关。IL-6水平与肺血管CTA、肌钙蛋白相关(P<0.05)。单因素logistic分析发现CD3水平、CD8水平和CD4/CD8比值差异有统计学意义。结论:T细胞免疫失衡在PE的发生、发展中作用显著,同时部分细胞因子和补体也可能起到了一定的作用。通过随访发现T细胞免疫功能随着病情的好转而得到改善。T细胞免疫功能指标与PE各项检测指标之间存在一定的相关性,提示部分T细胞表面分化抗原有望成为检测PE的有效指标。Objective：To define the role of immune function among patients with pulmonary thromboembolism（PE）and provide new thought of diagnosis and treatment.Method：A total of 70 patients with PE hospitalized in Tongji Hospital affiliated to Shanghai Tongji University and 20 control subjects were included.Tests including NYHA classification、serum biochemical index,electrocardiogram,chest radiography,echocardiography,pulmonary ventilation/perfusion imaging or CT pulmonary angiography were conducted in all subjects.Immunocyte superficial differential antigen、complement and cytokines were evaluated by flow cytometer（FCM）and these indexes were followed up closely.Result：CD3and CD8 levels were significantly lower in PE group（P〈0.05）while CD4/CD8 level was significantly higher（P〈0.05）.The follow-up status showed that D-dimer and NYHA classification levels improved significantly after 1/3months and 6months（P〈0.05）while CD3、CD4、CD4/CD8 levels changed significantly after 6months（P〈0.05）.Compared to the control group,complements、C3、C4and interleukin-6（IL-6）levels were significantly higher（P〈0.05）.The follow-up status showed that IL-6level changed significantly（P〈0.05）.We also found out that CD3 level was relevant to NYHA classification while CD8 levels and CD4/CD8 level were relevant to NYHA classification、CT pulmonary angiography、troponin and pro-BNP.Meanwhile,IL-6level was relevant to CT pulmonary angiography、troponin（P〈0.05）.Univariate logistic regression analysis showed that the levels of CD3、CD8and CD4/CD8 could be of considerable significance.Conclusion：Immune dysfunction of T cell as well as some complement and cytokines play an important role in the development and progress of PE.The follow-up status showed that Immune function of T cell can be restored as the condition of patients with PE improved.The relation between Immune function of T cells and some testing items of PE also was discovered which indicates that some Immunocyte superficial di

关 键 词：肺栓塞 免疫功能 T细胞免疫 细胞因子 补体系统 

分 类 号：R563.5[医药卫生—呼吸系统]