论文部分内容阅读
目的:明确免疫功能在肺动脉血栓栓塞症(pulmonary thromboembolism,PE)中的作用及为PE的防治提供新的诊疗思路。方法:选取在同济大学附属同济医院住院的PE患者70例(PE组),另选对照组20例。所有入选者均行下列检测:NYHA心功能分级,血生化指标,心电图,X线胸片,超声心动图,肺通气/灌注扫描或肺血管CT等;并通过流式细胞仪测定免疫细胞的表面分化抗原、补体及细胞因子等,同时随访各项指标变化。结果:PE组CD3、CD8显著降低(P<0.05),CD4/CD8比值显著升高(P<0.05),随访1或3个月和6个月时的D-二聚体和NYHA心功能与基础水平相比差异有统计学意义(均P<0.05);同时随访6个月时的CD3、CD8和CD4/CD8比值与基础值相比差异有统计学意义(P<0.05)。与对照组比较,PE组总补体、C3和C4、白细胞介素-6(interleukin-6,IL-6)均明显上升,差异有统计学意义(均P<0.05)。随访发现仅IL-6出现显著变化(P<0.05),CD3水平与NYHA心功能相关(P<0.05),CD8水平和CD4/CD8比值与NYHA心功能、肺血管CTA、肌钙蛋白和pro-BNP相关。IL-6水平与肺血管CTA、肌钙蛋白相关(P<0.05)。单因素logistic分析发现CD3水平、CD8水平和CD4/CD8比值差异有统计学意义。结论:T细胞免疫失衡在PE的发生、发展中作用显著,同时部分细胞因子和补体也可能起到了一定的作用。通过随访发现T细胞免疫功能随着病情的好转而得到改善。T细胞免疫功能指标与PE各项检测指标之间存在一定的相关性,提示部分T细胞表面分化抗原有望成为检测PE的有效指标。
Objective: To clarify the role of immune function in pulmonary thromboembolism (PE) and to provide new ideas for the prevention and treatment of PE. Methods: Seventy patients (PE group) with PE in Tongji Hospital Affiliated to Tongji University were selected and 20 patients in the control group were selected. All participants underwent NYHA cardiac function classification, blood biochemistry, electrocardiogram, X-ray, echocardiography, pulmonary ventilation / perfusion scan or pulmonary vascular CT, etc .; and the surface of immune cells was determined by flow cytometry Differentiation of antigens, complement and cytokines, at the same time follow-up changes in various indicators. Results: The levels of CD3 and CD8 in PE group were significantly decreased (P <0.05) and the ratios of CD4 / CD8 in PE group were significantly increased (P <0.05). The D-dimer and NYHA function in 1, 3 and 6 months follow- (P <0.05). At the same time, the ratio of CD3, CD8 and CD4 / CD8 at 6 months follow-up was significantly different from the baseline (P <0.05). Compared with the control group, the levels of total complement, C3 and C4, and interleukin-6 (IL-6) in PE group were significantly increased (all P <0.05). The levels of CD3 and the ratio of CD4 / CD8 were positively correlated with the NYHA function, pulmonary vascular CTA, troponin and pro-actin levels in the follow-up study (P <0.05) BNP related. IL-6 levels correlated with pulmonary vascular CTA and troponin (P <0.05). Univariate logistic analysis showed that CD3 level, CD8 level and CD4 / CD8 ratio had statistical significance. Conclusion: The imbalance of T cell immunity plays a significant role in the occurrence and development of PE, and some cytokines and complement may also play a role. Follow-up found that T cell immune function improved as the condition improved. There is a certain correlation between T cell immune function indexes and various test indexes of PE, suggesting that some T cell surface differentiation antigens are expected to be effective indicators for detecting PE.