标题：传染性单核细胞增多症患儿外周血T淋巴细胞亚群变化及其临床意义

      作者：李慧 1，刘晶 2，杨金英 3    1.西北妇女儿童医院儿童血液肿瘤科，陕西 西安 710003；2.宝鸡市妇幼保健院儿童感染科，陕西 宝鸡 721000；3.西安市人民医院(西安市第四医院)新生儿科，陕西 西安 710000

      卷次： 2023年34卷9期

      【摘要】 目的 探究传染性单核细胞增多症(IM)患儿外周血T淋巴细胞亚群变化及其临床意义。方法 选择2018—2020年宝鸡市妇幼保健院收治的 105例 IM患儿作为研究组，同期在医院体检的健康儿童100例作为对照组，应用流式细胞术检测两组儿童的外周血T淋巴细胞亚群(CD8+、CD4+、CD3+、CD4+/CD8+)水平，应用受试者工作特征曲线(ROC)曲线分析T淋巴亚群对 IM诊断价值；依据病程和病情严重程度进行分组，采用Spearman相关分析T淋巴亚群与病程和病情严重程度之间的关系。结果 研究组儿童的CD8+、CD3+分别为(40.33±7.26)%、(78.29±7.54)%，明显高于对照组的(21.59±6.28)%、(62.94±8.14)%，CD4+、CD4+/CD8+分别为(20.53±5.19)%、(0.63±0.19)，明显低于对照组的(35.94±6.57)%、(1.34±0.43)，差异均有统计学意义(P<0.05)；经ROC分析结果显示，CD8+、CD4+、CD3+、CD4+/CD8+用于 IM诊断曲线下面积(AUC)分别为 0.850、0.848、0.810、0.771。急性期组儿童的CD8+、CD3+分别为(44.23±5.79)%、(80.55±7.22)%，明显高于恢复期组的(33.16±2.89)%、(74.14±6.31)%，CD4+、CD4+/CD8+分别为(18.19±3.22)%、(0.59±0.17)，明显低于恢复期组的(24.83±5.40)%、(0.70±0.20)，差异均有统计学意义(P<0.05)；重症组儿童的CD8+、CD3+分别为(44.76±4.67)%、(81.11±8.25)%，明显高于轻症组的(33.94±5.29)%、(33.94±5.29)%，CD4+、CD4+/CD8+分别为(18.15±3.70)%、(0.56±0.17)，明显低于轻症组的(23.96±5.14)%、(0.73±0.18)，差异均有统计学意义(P<0.05)。经Spearman相关性分析结果显示，外周血CD8+、CD3+水平与病程呈负相关(r=-0.428，-0.625；P<0.05)，与病情严重程度呈正相关(r=0.494，0.614；P<0.05)；CD4+、CD4+/CD8+水平与病程呈正相关(r=0.509，0.722；P<0.05)，与病情严重程度呈负相关(r=-0.319，-0.747；P<0.05)。结论 IM患儿外周血T淋巴细胞亚群水平异常，可用于患者病情诊断及病情严重程度评估。
      【关键词】 传染性单核细胞增多症；外周血T淋巴细胞亚群；诊断价值；病情严重程度；临床意义
      【中图分类号】 R729 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1295—05

Changes and clinical significance of peripheral blood T lymphocyte subsets in children with infectiousmononucleosis.
LI Hui 1, LIU Jing 2, YANG Jin-ying 3. 1.Department of Pediatric Hematology and Oncology, NorthwestWomen's and Children's Hospital, Xi'an 710003, Shaanxi, CHINA; 2.Department of Child Infection, Baoji Maternal andChild Health Hospital, Baoji 721000, Shaanxi, CHINA; 3.Department of Neonatology, Xi'an People's Hospital (The FourthHospital of Xi'an, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To explore the changes and clinical significance of peripheral blood T lymphocyte sub-sets in children with infectious mononucleosis (IM). Methods A total of 105 children with IM admitted to Baoji Mater-nal and Child Health Hospital from 2018 to 2020 were selected as the study group, and 100 healthy children receivedphysical examination in the hospital during the same period were selected as the control group. The levels of peripheralblood T lymphocyte subsets (CD8+, CD4+, CD3+, CD4+/CD8+) were determined by flow cytometry. The diagnostic valueof T lymphocyte subsets for IM was analyzed by receiver operating characteristic (ROC) curve. The patients weregrouped according to disease duration and disease severity, and the relationship between T lymphoid subgroup and dis-ease duration and disease severity was analyzed by Spearman correlation. Results The levels of CD8+ and CD3+ in thestudy group were (40.33±7.26)% and (78.29±7.54)%, which were significantly higher than (21.59±6.28)% and (62.94±8.14)% in the control group, and the levels of CD4+ and CD4+/CD8+ were (20.53±5.19)% and 0.63±0.19, significanttlylower than (35.94±6.57)% and 1.34±0.43 in the control group (P<0.05). ROC curve analysis found that the area underthe curve values of CD8+, CD4+, CD3+ and CD4+/CD8+ for diagnosis of IM were 0.850, 0.848, 0.810, and 0.771, respec-tively. The levels of CD8+ and CD3+ in the acute phase group were (44.23±5.79)% and (80.55±7.22)%, which were sig-nificantly higher than (33.16±2.89)% and (74.14±6.31)% in the recovery phase group, and the levels of CD4+ and CD4+/CD8+ were (18.19±3.22)% and 0.59±0.17, significantly lower than (24.83±5.40)% and 0.70±0.20 in the recovery phasegroup (P<0.05). The levels of CD8+ and CD3+ in the severe group were (44.76±4.67)% and (81.11±8.25)%, which weresignificantly higher than (33.94±5.29)% and (33.94±5.29)% in the mild group, and the levels of CD4+ and CD4+/CD8+were (18.15±3.70)% and 0.56±0.17, significantly lower than (23.96±5.14)% and 0.73±0.18 in the mild group (P<0.05).Spearman correlation analysis results showed that peripheral blood CD8 + and CD3 + levels were negatively correlatedwith the course of the disease (r=-0.428, -0.625, P<0.05), and were positively correlated with the severity of the disease(r=0.494, 0.614, P<0.05). The levels of levels of CD4+ and CD4+/CD8+ were positively correlated with the course of thedisease (r=0.509, 0.722, P<0.05), and were negatively correlated with the severity of the disease (r=-0.319, -0.747, P<0.05). Conclusion The levels of peripheral blood T lymphocyte subsets are abnormal in children with IM, which canbe used for disease diagnosis and severity assessment of patients.
      【Key words】 Infectious mononucleosis; Peripheral blood T lymphocyte subset; Diagnostic value; Disease severi-ty; Clinical significance