论文部分内容阅读
目的 研究巨细胞病毒(CMV)病的发病情况、基础疾病、临床特点及淋巴细胞亚群改变特点,探讨CMV活动感染时的免疫改变及其免疫发病机制,提高CMV感染的诊疗水平。方法 50例CMV病患者均为2000年8月～2002年10月在北京协和医院住院的病人,男性15例,女性35例;年龄(35.5±16.2)岁。收集其临床资料并在确诊CMV病时留取其外周抗凝血进行淋巴细胞亚群检测。按照有无基础病将患者分为两组,并设51例健康人作为对照组,观察淋巴细胞亚群改变。结果(1)11例(22％)CMV病患者原无基础疾病,39例(78％)患有各种影响机体免疫功能的基础病,分别为系统性红斑狼疮(48％)、恶性肿瘤(8％)、糖尿病(8％)、艾滋病(6％)及接受肾移植等(8％)。(2)CMV pp65抗原及CMV特异性IgM抗体检测的阳性率分别为85.3％和68.3％。(3)常见的临床表现为发热(100％)、血液系统改变(96％)、肝功能损害(30％),也可表现为脏器功能衰竭、视网膜炎等。3例视网膜炎均为晚期艾滋病患者。(4)与对照组相比,CMV病患者不论是否存在基础病,其外周血B细胞、自然杀伤细胞数量均明显下降,CD8+ T细胞比例增高,CD4+/CD8+比值倒置;存在基础病组患者的总T淋巴细胞、CD4+ T细胞及CD8+ T细胞计数均显著少于无基础病组和对照组。结论 CMV病不仅可以累及免疫功能低下人群,也可以
Objective To study the pathogenesis, basic diseases, clinical features and changes of lymphocyte subsets of cytomegalovirus (CMV) in order to explore the immune changes and immune pathogenesis of CMV infection and to improve the diagnosis and treatment of CMV infection. Methods Fifty patients with CMV were hospitalized in Peking Union Medical College Hospital from August 2000 to October 2002. There were 15 males and 35 females with a mean age of 35.5 ± 16.2 years. The clinical data were collected and peripheral blood anticoagulants were collected for the detection of lymphocyte subsets when diagnosing CMV. The patients were divided into two groups according to the presence or absence of basic diseases, and 51 healthy people were taken as the control group to observe the changes of lymphocyte subsets. Results (1) Eleven patients (22%) had no underlying disease in CMV patients and 39 patients (78%) had underlying diseases that affected the immune function of patients with systemic lupus erythematosus (48%), malignant tumors 8%), diabetes (8%), AIDS (6%) and kidney transplantation (8%). (2) The positive rates of CMV pp65 antigen and CMV specific IgM antibody were 85.3% and 68.3% respectively. (3) Common clinical manifestations are fever (100%), changes in the blood system (96%), liver damage (30%), can also be manifested as organ failure, retinitis and so on. 3 cases of retinitis are advanced AIDS patients. (4) Compared with the control group, the number of B cells and natural killer cells in peripheral blood and the proportion of CD8 + T cells increased and the ratio of CD4 + / CD8 + increased in patients with CMV regardless of the underlying disease. Total T lymphocytes, CD4 + T cells and CD8 + T cell counts were significantly less than those without basal and control groups. Conclusion CMV disease can not only affect people with immunocompromised, but also can