新型冠状病毒肺炎无症状感染者的临床与免疫学特征分析  

Clinical and immunological characteristics of asymptomatic carriers of COVID-19

作　　者：申川[1] 秦浩[2] 马路园 李星宇 宋枚芳 张云涛[5] 高会霞[3] 王洋 戴二黑[3] 赵彩彦[1] SHEN Chuan;QIN Hao;MA Lu-yuan;LI Xing-yu;SONG Mei-fang;ZHANG Yun-tao;GAO Hui-xia;WANG Yang;DAI Er-hei;ZHAO Cai-yan(Department of Infectious Disease,the Third Hospital of Hebei Medical University,Clinical Research Center for Infectious Disease of Hebei Province,Hebei Key Laboratory for Diagnosis,Treatment,Emergency Prevention and Control of Critical Infectious Diseases,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院感染科河北省感染性疾病临床医学研究中心河北省重大传染病诊治与应急防控重点实验室,石家庄050051 [2]石家庄市第五医院重症医学科,050023 [3]石家庄市第五医院检验科,050023 [4]石家庄市第五医院感染一科,050023 [5]唐山市传染病医院肝病科

出　　处：《传染病信息》2022年第4期305-310,共6页Infectious Disease Information

基　　金：河北省重点研发计划项目(20277702D);河北省感染性疾病临床医学研究中心创新能力提升项目(20577704D);国家自然科学基金青年科学基金(81900536)。

摘　　要：目的 探讨新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)无症状感染者的临床和免疫学特征。方法 选取2020年1月22日—6月22日石家庄市第五医院收治的59例COVID-19患者作为研究对象,分析不同疾病分期患者的临床资料。利用流式细胞术检测患者外周血T淋巴细胞亚群计数,Procarta Plex多细胞因子检测系统检测外周血25种细胞因子和9种趋化因子水平。结果 59例COVID-19患者中,无症状感染组28例(47.5%)、轻型组6例(10.2%)、普通型组19例(32.2%),重型/危重型组6例(10.2%)。无症状感染组中位年龄为23.0(19.3,34.8)岁,显著低于普通型组的35.0(24.0,52.0)岁和重型/危重型组的64.5(52.0,68.3)岁(P均<0.05)。无症状感染组患者较少患有基础疾病,均无症状、体征和胸部CT变化,其外周血CD4^(+)T细胞、CD8^(+)T细胞计数均显著高于重型/危重型组(P均<0.05),同时CD4^(+)T细胞计数显著高于普通型组(P <0.05)。14例无症状感染组患者治疗前与治疗后CD4^(+)T细胞和CD8^(+)T细胞计数比较,差异均无统计学意义(P均> 0.05)。14例无症状感染组患者治疗前后CD4^(+)T细胞计数的变化幅度均显著低于普通型组、重型/危重型组(P均<0.05)。无症状感染组外周血可检测到11种细胞因子和趋化因子,其中IL-7水平显著高于对照组,IP-10水平均显著低于普通型组、重型/危重型组,差异均具有统计学意义(P均<0.05)。结论 COVID-19无症状感染者以青年为主,但未发现与性别因素相关。随着COVID-19病情进展,普通型、重型/危重型患者外周血T细胞亚群计数降低,而细胞因子和趋化因子水平升高,但上述指标在无症状感染者中未见显著改变。Objective To explore clinical and immunological characteristics of asymptomatic carriers of COVID-19.Methods Fifty nine cases with COVID-19 were admitted to the Shijiazhuang Fifth Hospital during January 22, and June 22, 2020,and the clinical data of patients were analyzed. The T lymphocyte subsets counts were analyzed by flow cytometry. Twenty-five serum cytokines and 9 chemokines release level in peripheral blood were detected by Procarta Plex. Result Of the 59 patients with COVID-19, there were 28 asymptomatic carriers(47.5%), 6 mild cases(10.2%), 19 moderate cases(32.2%), and 6 severe/critical cases(10.2%). The median age of asymptomatic carriers was 23.0(19.3, 34.8), which was significantly lower than moderate cases with 35.0(24.0, 52.0) and severe/critical cases with 64.5(52.0, 68.3)(P <0.05). Asymptomatic carriers had fewer underlying diseases, clinical symptoms, signs and thoracic abnormalities on computed tomography. The CD4^(+) T cell and CD8^(+) T cell counts in peripheral blood were significantly higher in asymptomatic carriers than those in severe/critical cases(P <0.05). The CD4^(+) T cell counts were significantly higher in asymptomatic carriers than those of moderate cases(P <0.05). The CD4^(+) T cell and CD8^(+) T cell counts before and after treatment displayed no significant changes in 14 asymptomatic carriers(P <0.05). The changes of CD4^(+) T cell counts before and after treatment in 14 asymptomatic carriers were significantly lower than those in moderate and severe/critical cases(P <0.05). Eleven cytokines and chemokines were detectable in serum of asymptomatic carriers. The level of IL-7 was significantly higher than that of control group, and the IP-10 was significantly lower compared with moderate and severe/critical cases(P <0.05). Conclusions The majority of COVID-19 asymptomatic carriers were young people, but there was no correlation with gender factors. With the progression of COVID-19, the counts of T cell subsets in periphery decreased in moderate and severe/critical patients, whil

关 键 词：新型冠状病毒肺炎 严重急性呼吸综合征冠状病毒2型 无症状感染者 临床特点 免疫应答 细胞因子 趋化因子 T细胞 

分 类 号：R512.99[医药卫生—内科学]