CD3＋、CD4＋、CD8＋T细胞和CD19＋B细胞在急性呼吸窘迫综合征发病中的作用  

Effect of CD3＋, CD4＋, CD8＋ T lymphocytes and CD19＋ B lymphocytes on the pathogenesis of acute respiratory distress syndrome

作　　者：畅毅平 张玉强[1] 张永利[1] 李超[2] 陈曲 Chang Yiping;Zhang Yuqiang;Zhang Yongli;Li Chao;Chen Qu(Department of Medical IC;Department of Clinical Laborator;Central Hospital of Baoji, Baoji 721008, Chin)

机构地区：[1]宝鸡市中心医院重症医学科,陕西省宝鸡721008 [2]宝鸡市中心医院检验科,陕西省宝鸡721008

出　　处：《中华急诊医学杂志》2018年第7期769-773,共5页Chinese Journal of Emergency Medicine

基　　金：陕西省宝鸡市科技局基金项目(2017SH2-1-1)

摘　　要：目的 探讨CD3＋、CD4＋、CD8＋T 细胞和CD19＋B 细胞在急性呼吸窘迫综合征（acuterespiratory distress syndrome，ARDS） 发病中的作用。方法 根据2012 年柏林定义的ARDS 的诊断标准，入选2016 年1 月至2017 年1 月宝鸡市中心医院重症医学科ARDS 患者34 例作为研究对象 （ARDS 组），选择同期健康体检者22 例为对照组，收集资料并进行跟踪随访。收集确诊ARDS 患者第1 天的临床资料，根据2012 年柏林定义分为中度组（20 例）和重度组（14 例），随访28 d 根据预后情况分存活组（20 例）和死亡组（14 例）。在患者确诊ARDS 第1 天, 清晨空腹抽外周静脉血3 mL，对照组抽空腹外周静脉血3 mL, 用流式细胞技术检测患者及和健康对照组血清CD3＋、CD4＋、CD8＋T 细胞和CD19＋B 细胞水平，将ARDS 组与健康对照组的CD3＋、CD4＋、CD8＋T 细胞和CD19＋B 细胞水平进行比较；将中度组和重度组的CD3＋、CD4＋、CD8＋T 细胞和CD19＋B 细胞 水平进行比较；将存活组和死亡组的CD3＋、CD4＋、CD8＋T 细胞和CD19＋B 细胞水平进行比较；采用多变量logistic 回归分析ARDS 预后的危险因素, 通过ROC 曲线分析预后指标。结果 确诊ARDS 第1 天，存活组和死亡组在乳酸、血清前白蛋白比较，差异有统计学意义（P〈0.05）；早 期ARDS 患者外周静脉血清CD3＋、CD4＋T 细胞和CD19＋B 明显低于健康对照组, 差异有统计学意义（P〈0.05）,CD8＋ 与健康组比较，差异无统计学意义（P〉0.05） ；中度组患者外周静脉血清CD3＋、CD4＋、CD8＋T 细胞和CD19＋B 水平明显高于重度组，差异有统计学意义（P〈0.05）；存活组患者 CD3＋、CD4＋、CD8＋T 细胞和CD19＋B 细胞水平明显高于死亡组，差异有统计学意义（P〈0.05）；Logistic 回归分析显示， 早期CD19＋B 细胞水平（OR=0.614, 95%CI ：0.416～0.907, P=0.014） 是ARDS 预后的危险因素。入院24 h 内CD19Objective To investigate the roles of CD3＋,CD4＋,CD8＋T lymphocytes and CD19＋B lymphocytes on the pathogenesis of acute respiratory distress syndrome（ARDS）. Methods According to Berlin definition Of ARDS in 2012, 34 patients with ARDS admitted in the Department of ICU of Central Hospital of Baoji from January,2016 to January,2017 were enrolled in this study as study group（ARDS group）. At the same time, 22 healthy subjects were recruited as control group. Clinical data of ARDS patients were collected, and the survivors were followed up. The ARDS patients were divided into moderate group（n=20） and severe group （n=14） according to clinical settings on the first day after diagnosis of ARDS and Berlin Definition of ARDS in 2012, and at the same time they were also divided into two groups according to the outcome followed up for 28 days： non-survival group（n= 14） and survival group（n=20）. Sample of 3 mL peripheral venous blood of ARDS patients was collected on an empty stomach in the early morning on the first day after diagnosis of ARDS and the blood samples of healthy subjects were also collected on the first day to measure the level of CD3＋,CD4＋,CD8＋ T cells and CD19＋ B cell in peripheral venous blood by flow cytometry. Comparison of CD3＋,CD4＋,CD8＋ T ceils and CD 19＋ B cell numbers were carried out between ARDS group and control group on the first day after diagnosis of ARDS, and between moderate group and severe group as well as between survival group and non- survival group. The risk factors associated with ARDS were analyzed using logistic regression analysis. Results On the first day after diagnosis of ARDS, there were significant differences in serum Lac and pre-albumin between survival group and non-survival group（P〈0.05）. The numbers of CD3＋,CD4＋T cells and CD19＋B cell of peripheral venous serum in ARDS group were significantly lower than those in control group（P〈0.05）, while there was no significant difference in CD8＋ T cell number between A

关 键 词：急性呼吸窘迫综合征 CD3+ CD4+ CD8+ CD19+ 发病机制 

分 类 号：R563.8[医药卫生—呼吸系统]