新型冠状病毒肺炎患者细胞免疫指标的动态演变及其对核酸转阴时间的影响  

Correlation between cellular immunological parameters dynamic evolution and the time from illness onset to negative for nucleic acid in COVID-19 patients

作　　者：孙峰[1] 杨建中[2] 刘雪梅[1] 燕存子[1] 周晨亮[3] SUN Feng;YANG Jian-zhong;LIU Xue-mei;YAN Cun-zi;ZHOU Chen-liang(Center of Pulmonary and Critical Care Medicine;Emergency Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,China;Department of Intensive Care Unit,the East Branch of People's Hospital of Wuhan University,Wuhan,Hubei 430200,China)

机构地区：[1]新疆医科大学第一附属医院呼吸与呼吸危重症中心,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院急救中心,新疆乌鲁木齐830054 [3]武汉大学人民医院东院重症医学科,湖北武汉430200

出　　处：《临床肺科杂志》2021年第12期1788-1793,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析新型冠状病毒肺炎(COVID-19)患者细胞免疫指标的动态演变及其对病毒核酸转阴时间的影响。方法回顾性分析在武汉大学人民医院东院收治并于2020年2月20日至2020年3月15日好转出院的COVID-19患者,以出现症状为起点,分析发病后0~4 d(P0)、5~7 d(P1)、8~10 d(P2)、11~14 d(P3)、15~21 d(P4)、22~28 d(P5)、29~35 d(P6)、36d以上(P7)8个时间点CD3、CD4、CD8、CD19、CD16+/56+的变化规律。按核酸转阴时间分为A组(≤30d)和B组(>30d),比较免疫指标的组间差异。结果共纳入116例患者细胞免疫结果238例次。CD3、CD4、CD8、CD19在各时间点间有显著性差异(P<0.05),在P2降至最低。广义线性混合模型分析发现,年龄增高,CD8下降,CD16+/56+升高。糖尿病者CD3、CD4、CD16+/56+下降。重型CD3、CD4较普通型降低。甲强龙组CD16+/56+下降。CD3、CD4、CD8在P3点B组显著低于A组(P<0.05)。ROC曲线分析P3点CD3、CD4、CD8计数预测核酸转阴时间延长的AUC分别为0.804、0.778、0.788(P<0.05)。结论新型冠状病毒感染可导致T淋巴细胞明显减少,CD3、CD4、CD8计数的持续降低可能预示核酸转阴时间延长,年龄、糖尿病和疾病严重程度,是影响细胞免疫指标的变化的危险因素。Objective To analyze the dynamic evolution of cellular immunological parameters of COVID-19 patients,and to study the correlation between these parameters with the time from illness onset to negative for nucleic acid.Methods In this retrospective study,it included all adult inpatients with laboratory-confirmed COVID-19 from the east hospital of People's Hospital of Wuhan University,who were recovered and discharged from February 20 to March 15,2020.The cellular immunological parameters,including CD3,CD4,CD8,CD19,CD16+/56+were extracted from electronic medical records.There were 8 periods according to the time from illness onset,0-4 d(P0),5-7 d(P1),8-10 d(P2),11-14 d(P3),15-21 d(P4),22-28 d(P5),29-35 d(P6),and above 36 d(P7).They were divided into two groups according to the time from illness onset to negative for SARS-CoV-2 RNA,the group A(≤30d)and the group B(>30d).These parameters were compared within these 8 periods and the two groups.Results The results of cellular immunity were extracted in 238 of 116 patients.There were significant differences in CD3,CD4,CD8 and CD19 within different time points,and their lowest level was at P2.Generalized linear mixed model analysis showed that CD8 count decreased and CD16+/56+count increased with age.The counts of CD3,CD4 and CD16+/56+decreased in patients with diabetes mellitus.CD3 and CD4 were lower in severe type than in ordinary type.The use of methylprednisolone only made the count of CD16+/56+count down.CD3,CD4 and CD8 were significantly lower in the group B at P3 than in the group A(P<0.05).The AUC of CD3,CD4 and CD8 counting at P3 was 0.804,0.778 and 0.788 respectively(P<0.05)by ROC curve analysis.Conclusion Novel coronavirus infection can significantly reduce the count of T lymphocytes,and sustain reduction of CD3,CD4,and CD8 counts may indicate prolonged the time to negative for nucleic acid.Age,diabetes mellitus and disease severity are the risk factors affecting the changes of cellular immune indexes.

关 键 词：新型冠状病毒肺炎 细胞免疫 核酸检测 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]