| 三氯乙烯药疹样皮炎患者治疗前后肝功能与外周血淋巴细胞亚群变化相关分析 |
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| 引用本文： | 吴奇峰,赵娜,李聪,梁伟辉,曾子芳,李斌,邓小峰. 三氯乙烯药疹样皮炎患者治疗前后肝功能与外周血淋巴细胞亚群变化相关分析[J]. 职业卫生与应急救援, 2014, 32(6): 331 |
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| 作者姓名： | 吴奇峰 赵娜 李聪 梁伟辉 曾子芳 李斌 邓小峰 |
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| 作者单位： | 广东省职业病防治院, 广东广州 510300 |
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| 基金项目： | 广东省医学科研基金(A2010057),广东省职业病防治院院课题(Z201002)。 |
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| 摘 要： | 目的 研究三氯乙烯药疹样皮炎患者治疗前后肝功能与外周血淋巴细胞亚群的变化特点,探索两者之间的联系,为该病发病机制的研究提供线索。 方法 采用双标法在流式细胞仪上对14例确诊为三氯乙烯药疹样皮炎的患者(其中9例为剥脱性皮炎、5例为多形红斑)在入院时及治疗2~3月后(停用糖皮质激素)进行外周血淋巴细胞亚群检测及肝功能指标检测,比较治疗前后肝功能与淋巴细胞亚群的变化情况。 结果 与正常参考值相比,治疗前患者均存在不同程度肝损伤,治疗后患者肝功能基本恢复正常。患者治疗前后的CD3+细胞、CD8+T细胞(CD3+CD8+)百分数均高于正常参考值,差异有统计学意义(t=2.283~6.841,P < 0.05或0.01);而CD4+T细胞(CD3+CD4+)、NK细胞[CD3-CD (16+56)+]、B淋巴细胞(CD3-CD19+)百分数、CD4+/CD8+比值均低于正常参考值,差异有统计学意义(t或Z=-14.49~-2.310,P < 0.05或0.01)。与治疗前比较,剥脱性皮炎患者治疗后的CD8+T淋巴细胞、B淋巴细胞百分数降低,趋于正常水平,差异有统计学意义(t=2.814、2.877,P < 0.05);其他指标在治疗前后比较,差异无统计学意义(P>0.05)。多形红斑患者各指标在治疗前后比较,差异均无统计学差异(P>0.05)。与入院时相比,免疫球蛋白M (IgM)、免疫球蛋白A (IgA)水平下降,差异有统计学意义(t=2.256、2.293,P < 0.05);免疫球蛋白G (IgG)水平在治疗前后比较,差异无统计学意义(t=1.783,P>0.05)。治疗前谷酰转肽酶水平与成熟T淋巴细胞(CD3+)、CD8+T细胞百分数均存在正相关关系(r=0.496、0.470,P < 0.05);胆碱酯酶、白蛋白等指标与成熟T淋巴细胞、CD8+T细胞百分数均存在负相关关系(r=-0.567、-0.475、-0.501,-0.516,P < 0.05)。 结论 三氯乙烯药疹样皮炎患者在较长的时间内存在免疫功能紊乱,三氯乙烯药疹样皮炎可能为细胞免疫与体液免疫共同作用的结果,CD8+T细胞的增殖可能与其肝脏和皮肤损害的机制有关。
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| 关 键 词： | 三氯乙烯药疹样皮炎 淋巴细胞亚群 肝功能 细胞免疫 |
| 收稿时间： | 2014-06-16 |
Changes of lymphocyte subsets and liver dysfunction in patients with dermatitis medicamentosa-like of trichloroethylene after treatment |
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| Abstract: | Objective The changes of lymphocyte subsets and liver dysfunction in patients with dermatitis medicamentosa-like of trichloroethylene were compared before and after treatments,to provide the clues for exploring the pathogenesis. Methods The lymphocyte subsets and liver dysfunction of 14 patients diagnosed as medicamentosa-like of trichloroethylene,including 9 cases of exfoliative dermatitis and 5 cases of erythema multiforme,were measured before hospitalization and 2-3 months after treatment (when the clinical use of glucocorticoid was stopped). Results The liver dysfunction was found at the beginning and the patients recovered after treatment. The percentages of CD3+, CD8+T lymphocyte cells were higher than the reference values (t=2.283 -6.841,P < 0.01),while the percentages of CD4+ (CD3+CD4+) T lymphocyte cell,NK (CD3-CD16+56+) lymphocyte cell,B (CD3-CD19+) lymphocyte cell and CD4+/CD8+ ratio were lower than the reference values both before and after treatments (t=-14.49——2.310,P < 0.01). The percentages of CD8+T lymphocyte and B lymphocyte cells of patients with exfoliative dermatitis were lower after treatment (t=2.814,2.877,P < 0.05).When lymphocyte subsets were compared among patients with erythema multiforme between before and after treatments,no statistically significant difference was noted. The numerical values of immunoglobulin M (IgM),immunoglobulin A (IgA) were lower after treatment (t=2.256,2.293,P < 0.05), while the numerical value of immunoglobulin G (IgG) had no statistically significant difference between before and after treatments (t=1.783,P>0.05). It was found that the GGT level at the beginning positive linear correlated with percentages of mature CD3+,CD8+ T lymphocyte cells (r=0.496,0.470, P < 0.05),while negative linear correlations were found between cholinesterase,albumin and mature CD3+,CD8+T lymphocytes cell (r=-0.567,-0.475,-0.501,-0.516,P < 0.05). Negative linear correlation was found between cholinesterase and lymphocytes cell after treatment (r=-0.608,P < 0.05). Conclusion Immune dysfunction may exist among the patients with dermatitis medicamentosa-like of trichloroethylene in a long time. DMLT may result from the joint action of cellular immunity and humoral immunity. The proliferation of CD8+T lymphocyte cells may involve the damaged mechanism of liver and skin. |
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