儿童危重型H1N1流感肺炎伴胸腔积液的临床特征及淋巴细胞亚型特征

目的分析危重症H1N1流感患儿合并胸腔积液的临床特征及自身免疫功能的变化。方法采用回顾性分析方法,收集2017年1月至2020年3月确诊为重症甲流的126例患儿的临床资料。根据有无胸腔积液分为胸腔积液阳性组(n=54)和胸腔积液阴性组(n=72);比较两组间基本临床资料,炎性指标和免疫功能。结果胸腔积液阳性组与阴性组性别、年龄、总住院时间、PICU住院时间、辅助通气时间、PCT、CRP均无统计学差异,但初始淋巴细胞数量胸腔积液阳性组(1.76×10⁹/L)低于阴性组(3.28×10⁹/L)(P=0.016)。淋巴细胞亚型比例方面,胸腔积液阳性组(CD3⁺T 35.94%,CD4⁺T 20.28%,CD8⁺T 10.78%)均明显低于胸腔积液阴性组(54.89%、34.80%、15.33%),但CD56⁺T阳性组(20.56%)高于阴性组(13.22%)(P<0.05)。而绝对数量上,胸水阳性组CD3⁺T,CD4⁺T和CD8⁺T细胞数分别为0.79×10⁹/L,0.48×10⁹/L,0.22×10⁹/L,显著少于阴性组1.65×10⁹/L,0.72×10⁹/L和0.48×10⁹/L(P<0.05),但CD56⁺T两组间没有差异。结论危重型甲流肺炎患儿合并胸腔积液者相比无胸腔积液者,具有更差的细胞免疫表现。

Clinical features of severe H1N1 influenza pneumonia children complicated with pleural effusion and its sub-type of leukomonocyte

Objective To analyze the clinical features and immunological changes of children with severe influenza H1N1 pneumonia complicated with pleural effusion.Methods A retrospective analysis was conducted.The clinical data of 126 children diagnosed with severe influenza H1N1 from January 2017 to March 2020 were collected.The subjects were divided into the positive group(n=54)and the negative group(n=72)according to the presence of pleural effusion.Basic clinical data,inflammatory factor and immune function were compared between the two groups.Results There was no difference in gender,age,duration of hospital stay and PICU stay,duration of ventilation,PCT and CRP between the two groups.The percentage of CD3⁺T,CD4⁺T and CD8⁺T were 35.94%,20.28%and 10.78%respectively in the positive group,which were lower than 54.89%,34.80%and 15.33%in the negative group,while CD56⁺NK were higher in the positive group(20.56%)than in the negative group(13.22%)respectively(P<0.05).The cell counts of CD3⁺T,CD4⁺T and CD8⁺T were 0.79×10⁹/L,0.48×10⁹/L,and 0.22×10⁹/L in the positive group,which were lower than those in the negative group(1.65×10⁹/L,0.72×10⁹/L,and 0.48×10⁹/L)(P<0.05),while no difference was presented in CD56⁺T in both groups.Conclusion Influenza H1N1 pneumonia children have worse immunological function with pleural effusion than without.