严重急性呼吸综合征患者淋巴细胞亚群的动态变化及意义

目的　了解成人严重急性呼吸综合征 (SARS)患者淋巴细胞亚群的改变对疾病的发生、发展及预后的影响。方法　依据卫生部颁发的传染性非典型肺炎临床诊断标准及预后将 2 0 6例SARS患者分为 3组 :即非重症组 13 3例、重症存活组 50例、重症死亡组 2 3例 ,用流式细胞仪进行淋巴细胞亚群CD4+、CD8+、CD19+、CD16+淋巴细胞的动态检测。建立数据库并对检测结果进行统计学分析。结果　SARS患者CD4+、CD8+、CD19+淋巴细胞计数均值分别是非重症组 >重症存活组 >重症死亡组 ,组间比较均P <0 .0 5。CD16+均值非重症组与重症存活组比较P >0 .0 5,两组与死亡组比较均P <0 .0 1。通过对CD4+、CD8+、CD19+、CD16+淋巴细胞计数动态观察 ,发现非重症组与重症存活组随病程CD4+、CD8+先下降后上升 ,CD19+随病程逐渐上升 ,CD 16+在发病早期有短暂的升高 ,然后波动在正常范围内。重症死亡组CD4+、CD8+、CD19+、CD16+在发病初期即处于较低水平 ,发病 15d后CD4+、CD8+、CD19+仍持续低水平 ,而CD16+随病程呈持续性降低。结论　成人SARS患者有明显的细胞免疫损伤 ,其淋巴细胞亚群的改变与临床分型及预后相关 ,对预后判断有一定的指导意义。SARS患者CD4+、CD8+淋巴细胞计数在发病初期是降低的 ,非重症组、重症存活组发病 9～15d是最

Dynamic changes and significance of subsets of blood lymphocyte in 206 adult severe acute respiratory syndrome patients

Objective To study the changing of subsets of blood lymphocyte in adult SARS patients and its effect on the clinical features and prognosis. Methods According to the clinical characteristic diagnostic standards of SARS recommended by the Ministry of Health of China, 206 of hospita lized SARS patients were divided into 3 groups: Mild-Moderate group included 13 3 patients; severe group 50 patients and death group 23 patients, and cells coun t changes of CD4 +, CD8 +, CD19 + and CD16 +. Statistic analyses were perfor med to analyze the relationship of immune changes and clinical features and prognosis. Results The counts of CD4 +, CD8 +, CD19 + lymphocytes in mild-moderate group were h igher than severe group, while lowest in death group (P<0.05). Except that t he NK cell counts between mild-moderate group and se vere group is non-statistical significant (P>0.05), there were significanl y difference in CD4 +, CD8 +,CD19 + and CD16 + cell counts among three grou ps(P<0.01). Exc ept for the death group, the observation of dynamic changes show that the CD4 + and CD8 + lymphocytes decreased at the beginning 15 days and then increased later and the CD19 + increased gradually from the begin ning. The death group cells count shows that the CD4 +, CD8 +, CD19 + and CD16 + cells kept in lower level continuously and CD16 + decreased continuously in later term. Conclusions The cellular immunity were severely damaged in adult SARS patients. The dynamic changes of lymphocytes were relevant with clinical features and prognosis. The counts of CD4 +, CD8 + lymphocytes in SARS patients showed significant low lev els at early phase of diseases, and reached the lowest levels from 9 to 15 days after onset of diseases. It is an important turning time points around day 15, after which the cell counts of T and B lymphocyte rose gradually and even return to the normal levels in some patients in mild- moderate g roup and severe group. But in the death group, the cell counts remained in low level until death. The results suggest that dynamic changes of lymphocytes, especially CD4 + and CD8 + T lymphocytes and B lymphocyte maybe is one of im portant markers to predict the clinical prognosis.