外周血CD4^(+)/CD8^(+)、D-二聚体水平与EB病毒感染相关噬血细胞综合征预后的关系探究  

Relationship between peripheral blood CD4^(+)/CD8^(+),D-dimer levels and the outcome of EBV-associated hemophagocytic syndrome

作　　者：王雨佳 李欣[1] 宋德利 王辰璐 WANG Yujia;LI Xin;SONG Deli;WANG Chenlu(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 [2]首都医科大学附属北京友谊医院血液内科,北京101100

出　　处：《中国感染与化疗杂志》2024年第5期558-563,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探究外周血CD4^(+)/CD8^(+)、D-二聚体(D-D)水平与EB病毒感染相关噬血细胞综合征(EBV-HLH)预后的关系。方法选取2021年9月—2023年8月首都医科大学附属北京友谊医院EBV-HLH患者90例设为观察组,同期另选取该院90例传染性单核细胞增多症(IM)患者设为对照组,比较两组外周血CD4^(+)/CD8^(+)、D-D水平,分析EBV-HLH患者外周血CD4^(+)/CD8^(+)、D-D水平与EBV-DNA载量的相关性;比较外周血不同CD4^(+)/CD8^(+)、D-D水平EBV-HLH患者3个月内预后情况,评价外周血CD4^(+)/CD8^(+)、D-D水平对EBV-HLH死亡风险的影响,分析外周血CD4^(+)/CD8^(+)、D-D水平的交互关系。结果观察组外周血CD4^(+)/CD8^(+)低于对照组,D-D水平高于对照组(P<0.05);EBV-HLH患者外周血CD4^(+)/CD8^(+)与EBV-DNA载量呈负相关(P<0.05),D-D水平与EBV-DNA载量呈正相关(P<0.05);外周血CD4^(+)/CD8^(+)高水平患者3个月内死亡率低于低水平患者,D-D高水平患者3个月内死亡率高于低水平患者(P<0.05);EBV-HLH患者外周血CD4^(+)/CD8^(+)低水平时,死亡风险是高水平的6.125倍;D-D高水平时,死亡风险是低水平的14.348倍,且CD4^(+)/CD8^(+)、D-D水平对该病患者死亡存在协同作用。结论EBV-HLH患者外周血CD4^(+)/CD8^(+)水平下降、D-D水平升高,且二者对该病患者死亡存在协同作用,检测其水平,有助于评估病情及预测预后风险。Objective To investigate the relationship between the levels of CD4^(+)/CD8^(+)and D-dimer(D-D)in peripheral blood and the outcome of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis(EBV-HLH).Methods Ninety patients with EBV-HLH who were treated in Beijing Friendship Hospital from September 2021 to August 2023 were included as observation group,and additional 90 patients with infectious mononucleosis(IM)treated in the hospital contemporarily were selected as the control group.The levels of CD4^(+)/CD8^(+)and D-D in peripheral blood were compared between the two groups of patients to examine the correlation between the levels of CD4^(+)/CD8^(+)and D-D in peripheral blood and EBV-DNA load in patients with EBV-HLH,compare the outcome of patients within 3 months in terms of the levels of CD4^(+)/CD8^(+)and D-D in peripheral blood,evaluate the effects of CD4^(+)/CD8^(+)and D-D levels in peripheral blood on the risk of death from EBV-HLH,and analyze the interaction between the levels of CD4^(+)/CD8^(+)and D-D in peripheral blood.Results The patients in observation group showed significantly lower peripheral blood CD4^(+)/CD8^(+)ratio and significantly higher D-D than the patients in control group(P<0.05).The peripheral blood CD4^(+)/CD8^(+)ratio was negatively correlated with EBV-DNA load(P<0.05),and D-D was positively correlated with EBV-DNA load(P<0.05)in EBV-HLH patients.The patients with high peripheral blood CD4^(+)/CD8^(+)ratio were assocaited with lower 3-month mortality rate compared to the patients with low CD4^(+)/CD8^(+)ratio.The patients with high D-D level were associated with higher 3-month mortality rate compared to the patients with low D-D level(P<0.05).In EBV-HLH patients with low levels of peripheral blood CD4^(+)/CD8^(+),the risk of death was 6.125 times that of the patients with high levels of CD4^(+)/CD8^(+).High level D-D was associated with 14.348 times risk of death compared to the patients with low level D-D.CD4^(+)/CD8^(+)and D-D had synergistic effect on death of EBV-HLH pati

关 键 词：EB病毒感染 噬血细胞综合征 EB病毒-DNA CD4^(+)/CD8^(+) 传染性单核细胞增多症 D-二聚体 

分 类 号：R511[医药卫生—内科学]