梅毒与梅毒合并病毒性肝炎患者外周血T淋巴细胞亚群变化*

目的 调查梅毒及其合并病毒性肝炎患者外周血T淋巴细胞亚群的变化。方法 2016年1月～2020年6月我院收治的93例感染苍白螺旋体(TP)梅毒患者中,单纯梅毒感染61例,TP合并CHB患者21例和TP合并CHC患者11例,另选择健康体检者84例。使用流式细胞仪检测外周血T淋巴细胞亚群。结果 梅毒患者外周血CD3⁺、CD4⁺、CD4⁺CD45RO⁺和CD8⁺CD45RA⁺细胞百分比及CD4⁺/CD8⁺细胞比值分别为(52.2±8.5)%、(40.3±5.7)%、(18.1±3.9)%、(12.4±3.7)%和(1.2±0.3),均显著低于健康人分别为(69.1±7.6)%、(50.7±6.9)%、(20.6±4.7)%、(16.2±4.3)%和(1.9±0.5),P＜0.05],而外周血CD8⁺、CD4⁺CD45RA⁺和CD8⁺CD45RO⁺细胞百分比显著高于健康人分别为(32.4±7.3)%、(24.7±6.5)%和(8.7±1.5)%对(26.2±5.4)%、(21.8±6.2)%和(5.4±1.1)%,P＜0.05];三组外周血CD8⁺、CD4⁺CD45RA⁺、CD4⁺CD45RO⁺、CD8⁺CD45RA⁺和CD8⁺CD45RO⁺细胞百分比及CD4⁺/CD8⁺细胞比值比较,差异有统计学意义(P＜0.05),TP合并CHB组和TP合并CHC组患者外周血CD8⁺、CD4⁺CD45RA⁺和CD8⁺CD45RO⁺细胞百分比均显著高于TP组(P＜0.05),而TP合并CHB组和TP合并CHC组患者外周血CD4⁺/CD8⁺比值、CD4⁺CD45RO⁺和CD8⁺CD45RA⁺细胞百分比显著低于TP组(P＜0.05),TP合并CHB组与TP合并CHC组患者外周血CD8⁺、CD4⁺CD45RA⁺、CD4⁺CD45RO⁺、CD8⁺CD45RA⁺和CD8⁺CD45RO⁺细胞百分比及CD4⁺/CD8⁺细胞比值比较均无统计学差异(P＞0.05)。结论 梅毒患者存在显著的外周血淋巴细胞亚群变化,合并CHB或合并CHC患者细胞免疫功能变化更明显,其临床意义值得进一步探讨。

Clinical implication of peripheral blood T lymphocyte subset changes in patients with syphilis and hepatitis B or hepatitis C coinfection

Objective The aim of this study was to investigate the clinical implication of peripheral blood T lymphocyte subset changes in patients with syphilis and hepatitis B or hepatitis C coinfection.Methods 93 patients with treponema pallidum(TP)syphilis were admitted to our hospital between January 2016 and June 2020,including syphilis infection in 61 cases,syphilis with hepatitis B virus infection in 21 cases and syphilis with hepatitis C virus infection in 11 cases.84 healthy persons were selected as the control.The peripheral blood T lymphocyte subsets was assayed by FCM.Results The percentages of peripheral blood CD3+,CD4+,CD4+CD45RO+and CD8+CD45RA+cells as well as the ratio of CD4+/CD8+cells in patients with syphilis were(52.2±8.5)%,(40.3±5.7)%,(18.1±3.9)%,(12.4±3.7)%and(1.2±0.3),all significantly lower than(69.1±7.6)%,(50.7±6.9)%,(20.6±4.7)%,(16.2±4.3)%and(1.9±0.5),respectively,P<0.05],while the percentages of peripheral blood CD8+,CD4+CD45RA+and CD8+CD45RO+cells were all significantly higher than those in healthy control(32.4±7.3)%,(24.7±6.5)%and(8.7±1.5)%vs.(26.2±5.4)%,(21.8±6.2)%and(5.4±1.1)%,respectively,P<0.05];there were significant differences as respect to the percentages of peripheral blood CD8+,CD4+CD45RA+,CD4+CD45RO+,CD8+CD45RA+,CD8+CD45RO+cells and the ratio of CD4+/CD8+cells among patients with TP,with TP and chronic hepatitis B(CHB),and with TP and chronic hepatitis C(CHC,P<0.05),the percentages of CD8+,CD4+CD45RA+and CD8+CD45RO+cells in patients with TP and CHB and patients with TP and CHC were all significantly higher than those in patients with TP(P<0.05),while the ratio of CD4+/CD8+cells,and the percentages of blood CD4+CD45RO+and CD8+CD45RA+cells were all significantly lower than those in patients with TP(P<0.05);there were no significant differences respect to the percentage of blood CD8+,CD4+CD45RA+,CD4+CD45RO+,CD8+CD45RA+and CD8+CD45RO+cells and the ratio of CD4+/CD8+cells between patients with TP and CHB,and those with TP and CHC(P>0.05).Conclusion The percentages of peripheral blood CD3+,CD4+,CD8+,CD4+CD45RA+,CD8+CD45RO+,CD4+CD45RO+,CD8+CD45RA+and the ratio of CD4+/CD8+cells in patients with TP change greatly,and those in patients with TP and HBV or HCV mixed infection change even significantly,which needs further clinical investigation.