[1]李彬钰a,马锡慧a,李 蕊a,等.老年新型冠状病毒感染患者外周血淋巴细胞亚群和多种细胞因子水平分析及其临床价值研究[J].现代检验医学杂志,2024,39(02):113-118+162.[doi:10.3969/j.issn.1671-7414.2024.02.021]
　LI Binyua,MA Xihuia,LI Ruia,et al.Analysis and Clinical Value of Lymphocyte Subsets and Various Cytokines of Peripheral Blood in Elderly Patients with COVID-19[J].Journal of Modern Laboratory Medicine,2024,39(02):113-118+162.[doi:10.3969/j.issn.1671-7414.2024.02.021]
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老年新型冠状病毒感染患者外周血淋巴细胞亚群和多种细胞因子水平分析及其临床价值研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年02期
页码:
113-118+162
栏目:
论著
出版日期:
2024-03-31

文章信息/Info

Title:
Analysis and Clinical Value of Lymphocyte Subsets and Various Cytokines of Peripheral Blood in Elderly Patients with COVID-19
文章编号:
1671-7414（2024）02-113-07
作者:
李彬钰1a; 马锡慧1a; 李 蕊1a; 米运强2; 韩 永1a; 孔祥瑞1a; 张彦辉1b
（1. 解放军总医院第八医学中心a. 呼吸与危重症医学部研究所；b. 康复医学科，北京 100091；2. 联勤保障部队第984 医院检验科，北京 100094）
Author(s):
LI Binyu1a;  MA Xihui1a;  LI Rui1a;  MI Yunqiang2;  HAN Yong1a;  KONG Xiangrui1a;  ZHANG Yanhui1b
(1a. Institute of Respiratory and Critical Care Medicine; 1b. Rehabilitation Medicine, PLA General Hospital No.8 Medical Center, Beijing 100091, China; 2. Department of Clinical Laboratory, the 984th Hospital of the Joint Logistics Support Force, Beijing 100094, China)
关键词:
老年; 新型冠状病毒肺炎; 淋巴细胞亚群; 细胞因子
分类号:
R373.1；R446.62
DOI:
10.3969/j.issn.1671-7414.2024.02.021
文献标志码:
A
摘要:
目的 探讨淋巴细胞亚群联合多种细胞因子在老年新型冠状病毒感染肺炎(coronavirus disease 2019，COVID-19) 感染患者疾病进展中的应用价值。方法 选取2022 年12 月~2023 年1 月解放军总医院第八医学中心应急病房收治的146 例老年COVID-19 确诊患者，根据预后分成两组：生存组（n=127）和死亡组（n=19），另收集老年医学科51 例骨质疏松患者作为对照组。比较对照组与新冠组、生存组与死亡组患者的包括T，B 和NK 等重要淋巴细胞亚群的比例和绝对计数，以及血浆12 项细胞因子（包括IL-1β，IL-2，IL-4，IL-5，IL-6，IL-8，IL-10，IL-12p70，IL-17，TNF-α，IFN-α 和IFN-γ）水平。应用受试者工作特征（receiver operating characteristic，ROC）曲线评价其在预测老年COVID-19 感染患者预后的价值。结果 与对照组比较：①新冠组的NK 细胞比例降低，B 细胞比例升高，差异有统计学意义（Z=-3.386，-4.140，P<0.01）；T，CD8+T，CD4+T 细胞比例差异均无统计学意义（Z=-1.244，-1.770，-0.951，均P>0.05）。②新冠组的T，CD8+T，CD4+T，NK 和B 细胞绝对数均降低，差异有统计学意义（Z=-9.418~-6.539，均P<0.01）。③新冠组的IL-2，IL-6，IL-1β，IFN-γ，IL-8，IL-17，IL-12p70 和IL-10 浓度均升高，差异有统计学意义（Z=-8.851~-1.986，均P<0.05）；IL-5，IFN-α，TNF-α 和IL-4 浓度差异均无统计学意义（Z=-0.460~-0.217，均P>0.05）。与生存组比较：①死亡组的T，CD8+T，CD4+T，NK，B 细胞比例差异均无统计学意义（Z=-1.873~-0.422，均P>0.05）。②死亡组的T，CD8+T，CD4+T 细胞绝对数均降低，差异有统计学意义（Z=-2.667，-2.287，-2.556，均P<0.05）；NK，B 细胞绝对数差异均无统计学意义（Z=-1.934，-0.532，均P>0.05）。③死亡组的IL-6，IFN-γ，IL-8，IL-17 和IL-10 浓度均升高，差异有统计学意义（Z=-4.211~-2.655，均P<0.05）；IL-5，IFN-α，IL-2，IL-1β，IL-12p70，TNF-α 和IL-4 浓度差异均无统计学意义（Z=-1.329~-0.279，均P>0.05）。ROC 曲线分析淋巴细胞亚群联合细胞因子对老年COVID-19 患者的预后预测价值显示：总T 细胞、B 细胞和NK 细胞数量在预测新冠感染预后的ROC 曲线下面积分别为0.94，0.80 和0.93；其中CD4+T 细胞CD8+T 细胞数量在预测COVID-19 感染预后的ROC 曲线下面积分别为0.93 和0.90；细胞因子中的IL-6，IFN-γ，IL-8，IL-17 和IL-10 在预测COVID-19 感染预后的ROC 曲线下面积分别为0.91，0.71，0.87，0.74 和0.90；而联合淋巴细胞亚群和细胞因子在预测新冠感染预后的ROC 曲线下面积达到0.99。结论 老年患者在新型冠状病毒感染时免疫呈全面低下状态，评估免疫状态对疾病诊断、病情观察以及预后等方面具有重要的临床指导意义。
Abstract:
Objective To explore the application value of lymphocyte subsets combined with various cytokines in the disease progression of elderly patients with corona virus disease 2019(COVID-19). Methods From December 2022 to January 2023, 146 elderly patients with COVID-19 diagnosed in the emergency ward of the Eighth Medical Center of PLA General Hospital were selected and divided into two groups according to the prognosis: 127 cases in the COVID-19 survival group, 19 cases in the COVID-19 death group. In addition, 51 osteoporosis patients in geriatric medicine department were collected as control group.The proportion and absolute count of lymphocyte subsets (including T, B and NK cells), and 12 cytokines in plasma (including IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, TNF-α and IFN-γ) were compared between the control group and COVID-19 group, survival group and death group. The receiver operating characteristic (ROC) curve was used to evaluate its prognostic value in elderly patients with COVID-19 infection. Results Compared with the control group: ① The proportion of NK cells in COVID-19 group was decreased, while the proportion of B cells was increased, and the differences were statistically significant（Z=-3.386，-4.140，all P<0.01）. There was no significant difference in the proportion of T, CD8+T and CD4+T cells, and the differences were not statistically significant（Z=-1.244，-1.770，-0.951，all P>0.05）. ② The absolute numbers of T, CD8+T, CD4+T, NK and B cells in COVID-19 group were decreased, and the differences were statistically significant （Z= -9.418~-6.539，all P<0.01）. ③ The concentrations of IL-2, IL-6, IL-1β, IFN-γ, IL-8, IL-17, IL-12P70 and IL-10 in COVID- 19 group were all increased, and the differences were statistically significant（Z=-8.851~-1.986，all P<0.05）. There was no significant difference in the concentrations of IL-5, IFN-α, TNF-α and IL-4, and the differences were not statistically significant （Z=-0.460~-0.217，all P>0.05）. Compared with the survival group: ① There was no significant difference in the proportion of T, CD8+T, CD4+T, NK and B cells in the death group（Z=-1.873~-0.422，all P>0.05）. ② The absolute numbers of T, CD8+T and CD4+T cells in the death group were all decreased, and the differences were statistically significant（Z=-2.667，- 2.287，-2.556，all P<0.05）, while there was no significant difference in absolute numbers of NK and B cellsm and the differences were not statistically significant （Z=-1.934，-0.532，all P>0.05）. ③ The concentrations of IL-6, IFN-γ, IL-8, IL-17 and IL-10 in the death group were all increased, and the differences were not statistically significant（Z=-4.211~-2.655， all P<0.05）, and there was no significant difference in the concentrations of IL-5, IFN-α, IL-2, IL-1β, IL-12p70, TNF-α and IL-4 the differences were not statistically significant（Z=-1.329~-0.279，all P>0.05）. ROC curve analysis for the prognostic value of lymphocyte subsets combined with cytokines in elderly patients with COVID-19 showed that: the areas of total T cells, B cells and NK cells under ROC curve for predicting the prognosis of COVID-19 infection were 0.94, 0.80 and 0.93, respectively. The areas of CD4+T cells and CD8+T cells under ROC curve for predicting the prognosis of COVID-19 infection were 0.93 and 0.90, respectively. The areas of IL-6, IFN-γ, IL-8, IL-17 and IL-10 in cytokines under the ROC curve for predicting the prognosis of COVID-19 infection were 0.91, 0.71, 0.87, 0.74 and 0.90, respectively. However, the area of combined lymphocyte subsets and cytokines under ROC curve for predicting the prognosis of COVID-19 infection reached 0.99. Conclusion The immune status of elderly patients with COVID-19 was generally low. Evaluation of immune status has important clinical guidance significance in disease diagnosis, disease observation and prognosis.

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备注/Memo

备注/Memo:
基金项目：首都卫生发展科研专项（项目号：首发2022-2-5092）：慢性阻塞性肺疾病患者的免疫功能评估模型的建立。
作者简介：李彬钰（1991-）女，本科，技师，主要研究方向：临床免疫，E-mail: willyu0616@163.com。
通讯作者：张彦辉，E-mail: 15210468343@163.com。
更新日期/Last Update: 2024-03-15