摘要
目的探讨COPD急性加重期患者外周血淋巴细胞的免疫分型、NK细胞水平变化的临床价值。方法90例慢性阻塞性肺疾病急性加重期患者,根据肺功能FEV1predicted、血气分析结果、改良版英国医学研究委员会呼吸问卷、病程长短不同分为多个亚组,同时选取25例健康人作为正常对照组,采用流式细胞术检测外周血中CD3^+、CD4^+、CD8^+、CD56^+NK细胞、CD19^+B淋巴细胞表达水平,计算CD4^+/CD8^+比值,比较每个观察指标各亚组间的外周血淋巴细胞各亚群的差异,同时与正常对照组做比较。结果 CD3^+及CD3^+CD4^+淋巴细胞无呼吸衰竭组较呼吸衰竭组及正常对照组明显增高(均P<0.01),CD3^+CD4^+/CD3^+CD8^+淋巴细胞比值无呼吸衰竭组与呼吸衰竭组及正常对照组相比均明显增高(P<0.05);CD3-CD56^+NK细胞呼吸衰竭组较无呼吸衰竭组明显增高。CD3^+淋巴细胞mMRC 0-1级组与正常对照组及mMRC3-4级组比较,均明显增高,前者P<0.05,后者P<0.01;mMRC 2-3级组较mMRC3-4级组明显增高(P<0.05)。CD3^+CD4^+淋巴细胞mMRC2-3级组较正常对照组及mMRC3-4级组明显增高(均P<0.01),CD3^+CD56^+NK细胞mMRC3-4级组与mMRC 0-1级组比较明显增高(P<0.05),CD4^+T细胞肺功能III级组较正常对照组明显增高(P<0.05);CD3^+淋巴细胞病程≤10年组较正常对照组明显升高(P<0.05);除此外,其余各亚组间相比,外周血淋巴细胞免疫分型指标均无显著差异。结论 COPD急性加重期患者存在明显的淋巴细胞免疫功能紊乱,主要表现为COPD患者早期至中期阶段,无呼吸衰竭之前,以CD3^+、CD3^+CD4^+淋巴细胞参与COPD的炎症反应为主;有呼吸衰竭时以CD3-CD56^+NK细胞参与COPD的炎症反应为主。参与体液免疫反应的淋巴细胞无明显异常,说明细胞免疫异常在呼吸道炎症进展过程中起重要作用。
Objective To explore the Clinical value of peripheral blood lymphocyte immunophenotyping and CD56~＋NK cell levels in patients with COPD with acute exacerbation.Methods 90 patients with COPD with acute exacerbation,they were divided into several subgroups according to the lung function FEV1 predicted、blood-gas？analysis、the modified version British Medical Research Council＇s respiratory questionnaire（mMRC）、duration of disease.25 cases of healthy as the normal control.The levels of CD3~＋、CD4~＋、CD8~＋、CD56~＋NK、CD19~＋B cell of peripheral blood were determined by a flow cytometry.CD4~＋/CD8~＋ratio was calculated.The differences between several subgroups of peripheral blood lymphocyte subsets of every indexes were compared;while compared with the control group.Results COPD patients with acute exacerbation：compared with respiratory failure subgroup and control group,the levels of CD3~＋、CD4~＋T cells,CD4~＋/CD8~＋ratio in without respiratory failure subgroup were significantly higher（P〈0.01 or P〈0.05）;compared without respiratory failure subgroup,CD3-CD56~＋NK cells in respiratory failure subgroup were significantly higher（P〈0.01）.compared with control group and mMRC 3-4 subgroup,the levels of CD3~＋T cells in mMRC0-1 subgroup were significantly higher（P〈0.05 or P〈0.01）;compared with mMRC3-4 subgroup,the levels of CD3~＋T cells in mMRC 2-3 subgroup were also higher（P〈0.05）;compared with mMRC3-4 subgroup and control group,the levels of CD3~＋CD4~＋T cells in mMRC2-3 subgroup were significantly higher（P〈0.01）;compared with mMRC 0-1 subgroup,the levels of CD3-CD56~＋NK cells in mMRC3-4 subgroup were higher（P〈0.05）.the levels of CD4~＋T cells in lung function level III group was significantly higher than that in control group（P〈0.05）.the levels of CD3~＋T cells in the course of 10 years or less subgroup were significantly higher than that in control group（P〈0.05）;except addition,there was no obvious difference in various i
作者
杨东升
刘培培
侯松萍
YANG Dong-sheng;LIU Pei-pei;HOU Song-ping.(Department of Respiratory Medicine, China-Japan Union Hos- pital, J i Lin University, Changchun 130033, China)
出处
《中国实验诊断学》
2018年第3期426-430,共5页
Chinese Journal of Laboratory Diagnosis
关键词
慢性阻塞性肺病
淋巴细胞亚群
NK细胞
综合评估
Chronic obstructive pulmonary disease
Lymphocyte subsets
NK cells
Comprehensive evaluation
