35例COVID-19患者外周血白细胞及T淋巴细胞亚群的动态变化  

Dynamic changes of peripheral white blood cells and T-lymphocyte subsets in patients with COVID-19

作　　者：郝建志[1] 曹举潮[1] 黄晓青[2] 李晓锋[3] 黄馨 王燕[5] 黎国威 江奕恒[1] 黎程[2] Hao Jianzhi;Cao Juchao;Huang Xiaoqing;Li Xiaofeng;Huang Xin;Wang Yan;Li Guowei;Jiang Yiheng;Li Cheng(Emergency Department,Guangdong Second Provincial General Hospital,Guangzhou 510317,China;Guangdong Second Provincial General Hospital,Research Institute of Traditional Chinese Medicine and Sports Rehabilitation in Guangdong,Guangzhou 510317,China;Second Department of General Surgery,Guangdong Second Provincial General Hospital,Guangzhou 510317,China;Center of Clinical Epidemic Diseases and Methodology,Guangdong Second Provincial General Hospital,Guangzhou 510317,China;Department of Respiratory Medicine,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院急诊科,广州510317 [2]广东省第二人民医院广东省传统医学与运动康复研究所,广州510317 [3]广东省第二人民医院普外二科,广州510317 [4]广东省第二人民医院临床流行病与方法学中心,广州510317 [5]广东省第二人民医院呼吸内科,广州510317

出　　处：《国际医药卫生导报》2021年第23期3625-3630,共6页International Medicine and Health Guidance News

基　　金：广东省中医药局新冠肺炎中医药防治临床研究应急项目(2020ZYYJ09)。

摘　　要：目的探讨新型冠状病毒肺炎(coronavirusdisease 2019,COVID-19)患者外周血白细胞和T淋巴细胞亚群的变化及其临床意义。方法收集2020年1月至2月广东省第二人民医院收治的35例COVID-19患者住院期间的血常规及T淋巴细胞亚群检测结果,并进行病程组间比较。结果共35例患者,其中男19例,女16例,年龄12~74(44.63±14.80)岁。1例患者无任何症状,其余34例患者发病至住院时间间隔为1~25 d,中值为3.50 d。35例患者中有4例在住院第4~7天转外院治疗,其余31例全部治愈出院,住院10~36(21.29±7.93)d。转院患者中转院前诊断普通型、重型各2例,其余31例轻型4例、普通型26例、重型1例,无危重型。住院第1天COVID-19患者白细胞、中性粒细胞计数较参考值明显下降;住院第1、3、5、7天淋巴细胞计数及血小板计数均明显低于参考值。病程前2周CD3^(+)、CD4^(+)T细胞计数以及前3周CD8^(+)T细胞计数均明显降低;病程第3、4周CD3^(+)、CD4^(+)、CD8^(+)T细胞绝对值计数均明显高于第1周;随着病程的延长,CD3^(+)、CD4^(+)、CD8^(+)T细胞绝对值计数也在逐渐上升。轻型患者[男2例,女2例,年龄(25.00±11.11)岁]住院第1天的淋巴细胞比值高于普通型患者[男12例,女14例,年龄(46.81±12.81)岁]。在病程第2周时,16例普通型患者CD3^(+)、CD4^(+)、CD8^(+)T细胞绝对值计数均明显低于3例轻型患者。结论新型冠状病毒(SARS-CoV-2)一过性损伤机体的细胞免疫功能;白细胞以及T淋巴细胞亚群的变化对阐明COVID-19的发病机制、判断病情严重程度、指导临床合理用药等具有一定意义。Objective To investigate the dynamic changes of peripheral white blood cells and T-lymphocyte subsets in patients with COVID-19 and the clinical significance.Methods The results of blood routine test and T-lymphocyte subsets of 35 COVID-19 patients treated at Guangdong Second Provincial General Hospital from January to February 2020 were collected,and compared between the different course groups.Results There were 35 patients,including 19 males and 16 females.They were 12-74(44.63±14.80)years old.One patient had no symptoms,and the intervals between onset and admission of the other 34 patients were 1-25 d,with a median of 3.50.Among the 35 patients,4 were transferred to other hospitals 4-7 d after admission,and the rest 31 were cured and discharged after being at hospital for 10-36((21.29±7.93)d)days.Among the 4 transferred patients,2 got common type,and 2 severe type.Among the rest 31,4 had mild type,26 common type,1 severe type,and no critical type.The counts of white blood cells and neutrocytes on day 1 of hospitalization and the numbers of lymphocytes and platelet on day 1,3,5,and 7 decreased as compared with the references.The counts of CD3^(+)and CD4^(+)T lymphocytes during the first 2 weeks of the disease course and the count of CD8^(+)T lymphocytes during the first 3 weeks significantly decreased.The counts of CD3^(+),CD4^(+),and CD8^(+)T lymphocytes during week 3 and 4 of the disease course were obviously higher than those during week 1.As the disease course prolonged,the counts of CD3^(+),CD4^(+),and CD8^(+)T lymphocytes increased.The mild type patients[2 males and 2 females,with an age of(25.00±11.11)]had a higher ratio of lymphocytes than the common type patients[12 males and 14 females,with an age of(46.81±12.81)]on day 1 of the admission.During week 2 of the disease course,16 common type patients had obviously lower counts of CD3^(+),CD4^(+),and CD8^(+)T lymphocytes than 3 mild type patients.Conclusions SARS-CoV-2 attacks cellular immune function temporarily.The study of changes of white blood c

关 键 词：COVID-19 白细胞 T淋巴细胞亚群 

分 类 号：R563.1[医药卫生—呼吸系统]