成人继发性噬血细胞综合征患者临床特征、T_(H)17/Treg细胞和淋巴细胞亚群变化及意义  

Clinical characteristics and changes and significance of T_(H)17/Treg cells and lymphocyte subsets in adult secondary hemophagocytic syndrome

作　　者：王雨佳 彭喆 王辰璐 李欣[1] 张涛[1] WANG Yujia;PENG Zhe;WANG Chenlu;LI Xin;ZHANG Tao(Department of Laboratory Medicine,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京友谊医院检验科,北京101100

出　　处：《临床检验杂志》2024年第9期659-663,共5页Chinese Journal of Clinical Laboratory Science

摘　　要：目的探究成人继发性噬血细胞综合征(sHLH)患者的临床特征,并分析其T_(H)17/Treg细胞、淋巴细胞亚群变化及意义,以期为临床治疗提供参考。方法选取2021年4月至2023年3月北京友谊医院收治的82例成人sHLH患者,入院次日统计其临床特征资料,并检测T_(H)17/Treg细胞(T_(H)17、Treg、T_(H)17/Treg)、淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD19^(+)、CD16^(+)CD56^(+))水平。给予HLH-2004治疗方案并随访6个月,根据治疗结果分为生存组(57例)和病死组(25例),比较两组入院次日T_(H)17/Treg细胞、淋巴细胞亚群水平,进一步分析T_(H)17/Treg细胞与淋巴细胞亚群的相关性以及对成人sHLH患者病死的评估价值。结果82例成人sHLH患者均存在血β2微球蛋白和血清铁蛋白升高,90%以上患者存在持续性不规则高热、浆膜腔积液、血细胞减少、肝功能损害等临床特征。入院次日、治疗1个月、治疗2个月、治疗3个月时生存组T_(H)17、T_(H)17/Treg水平均低于病死组,而Treg水平高于病死组(P<0.05);CD3^(+)、CD8^(+)T细胞水平低于病死组,而CD4^(+)、CD16^(+)CD56^(+)淋巴细胞水平高于病死组(P<0.05)。T_(H)17/Treg细胞、淋巴细胞亚群各指标联合预测成人sHLH患者病死的AUC^(ROC)为0.853(95%CI:0.758~0.922),均高于各指标单独预测(P<0.05)。结论成人sHLH患者的临床特征复杂多样,存在明显T_(H)17/Treg免疫功能紊乱、淋巴细胞亚群免疫功能失调,T_(H)17/Treg细胞、淋巴细胞亚群各指标联合预测成人sHLH患者预后具有较高的临床效能。Objective To investigate the clinical characteristics of adult secondary hemophagocytic syndrome(sHLH)and analyze the changes and significance of T_(H)17/Treg cells and lymphocyte subsets,providing favorable references for clinical work.Methods 82 adult sHLH patients admitted to our hospital from April 2021 to March 2023 were selected.On the second day of admission,we observed their clinical characteristics and detected the levels of T_(H)17/Treg cells(T_(H)17,Treg,T_(H)17/Treg)and lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD19^(+),CD16^(+)CD56^(+)).The patients were given the HLH-2004 treatment regimen and followed up for 6 months.According to the treatment results,they were divided into the survival group(n=57)and fatality group(n=25).The levels of T_(H)17/Treg cells and lymphocyte subsets on the second day of admission between the two groups were compared.The correlation between T_(H)17/Treg cells and lymphocyte subsets and the value of T_(H)17/Treg cells in evaluating the fatality of adult sHLH patients were analyzed.Results All 82 adult sHLH patients had elevated serum beta-2 microglobulin and ferritin levels,and more than 90%of patients had clinical characteristics such as persistent irregular high fever,serous cavity effusion,decreased blood cells,and liver function damage.The levels of T_(H)17,T_(H)17/Treg,CD3^(+),and CD8^(+)T cells on the second day of admission,1 month,2 months,and 3 months after treatment in the survival group were significantly lower than those in the fatality group(P<0.05),while the levels of Treg,CD4^(+),and CD16^(+)CD56^(+)lymphocytes were the opposite(P<0.05).The area under the reciever operating characteristics curve(AUC^(ROC))of T_(H)17/Treg cells combined with lymphocyte subsets in predicting the fatality of adult sHLH patients was 0.853(95%CI:0.758-0.922),which was higher than that of each individual indicator(P<0.05).Conclusion The clinical characteristics of adult sHLH are complex and diverse,with significant immune dysfunction of T_(H)17/Treg and lymphocyte subsets.The T_(

关 键 词：噬血细胞综合征 成人 继发性 T_(H)17 TREG 淋巴细胞亚群 

分 类 号：R446[医药卫生—诊断学] R551.12[医药卫生—临床医学]