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。
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-αand 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:①The 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).②The 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).③The 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-αand IL-4,and the differences were not statistically significant(Z=-0.460~-0.217,all P>0.05).Compared with the survival group:①There 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).②The 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).③The 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-αand 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.
作者
李彬钰
马锡慧
李蕊
米运强
韩永
孔祥瑞
张彦辉
LI Binyu;MA Xihui;LI Rui;MI Yunqiang;HAN Yong;KONG Xiangrui;ZHANG Yanhui(Institute of Respiratory and Critical Care Medicine,PLA General Hospital No.8 Medical Center,Beijing 100091,China;Rehabilitation Medicine,PLA General Hospital No.8 Medical Center,Beijing 100091,China;Department of Clinical Laboratory,the 984th Hospital of the Joint Logistics Support Force,Beijing 100094,China)
出处
《现代检验医学杂志》
CAS
2024年第2期113-118,162,共7页
Journal of Modern Laboratory Medicine
基金
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。
