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目的:研究静脉血栓栓塞症(VTE)患者、VTE合并感染患者、单纯感染患者与正常对照者之间T淋巴细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)水平变化及超敏C-反应蛋白(high-sensitivity C-reactive protein,hsCRP)的差异。方法:入组289例患者,其中对照组82例,单纯VTE组68例(VTE组),VTE合并感染组44例(合并组),单纯感染组95例(感染组)。分别检测T淋巴细胞亚群CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、hsCRP、空腹血糖及血脂系列。结果:感染组与对照组相比,CD3~+、CD4~+、CD8~+T细胞均显著降低,CD4~+/CD8~+显著升高(P<0.05),而VTE组、合并组与对照组相比主要表现为CD3、CD8~+T细胞显著降低,CD4~+/CD8~+升高(P<0.05),而CD4~+T细胞无显著改变(P>0.05)。VTE组、合并组和感染组组间比较差异无统计学意义(P>0.05),但VTE组CD8~+T细胞下降和CD4~+/CD8~+升高均较感染组和合并组明显。同时笔者观察了4组间CD值过低、正常及过高各占比例,并行χ2值检验,结果发现对照组与其他3组比较差异均有统计学意义,主要表现在CD3~+和CD8~+T细胞下降的比例升高;CD4~+/CD8~+升高的比例显著增多。而除外对照组的3组间除VTE组与感染组CD3~+T细胞存在微小差异外(P=0.043),其余均差异无统计学意义(P>0.05)。炎性因子hsCRP在VTE组、合并组、感染组中均明显升高。结论:VTE和感染患者均存在免疫功能紊乱,而VTE患者多合并感染,本研究发现VTE患者T淋巴细胞亚群变化独立于感染导致T细胞免疫功能紊乱,提示VTE本身存在T细胞免疫功能异常。VTE患者整体的T细胞识别抗原和转导活化信号的功能下降,同时T细胞直接杀伤病毒微生物的功能显著下降,炎症免疫机制参与了静脉血栓的发生发展。
Objective: To investigate the relationship between T lymphocyte subsets (CD3 ~ +, CD4 ~ +, CD8 ~ +, CD4 ~ + / CD8 ~ +) in patients with venous thromboembolism (VTE), patients with VTE infection, patients with simple infection and normal controls +) Levels and high-sensitivity C-reactive protein (hsCRP). Methods: A total of 289 patients were enrolled. Among them, 82 patients in the control group, 68 patients in the simple VTE group (VTE group), 44 patients in the VTE combined infection group (combined group) and 95 patients in the simple infection group (infection group). The T lymphocyte subsets CD3 ~ +, CD4 ~ +, CD8 ~ +, CD4 ~ + / CD8 ~ +, hsCRP, fasting blood glucose and serum lipids were detected respectively. Results: Compared with control group, CD3 ~ +, CD4 ~ + and CD8 ~ + T cells in infected group were significantly decreased and CD4 ~ + / CD8 ~ + were significantly increased Compared with control group, CD3 and CD8 + T cells were significantly decreased and CD4 ~ + / CD8 + increased (P <0.05), while CD4 ~ + T cells showed no significant change (P> 0.05). There was no significant difference between the VTE group, the combined group and the infected group (P> 0.05). However, the decrease of CD8 + T cells and the increase of CD4 + / CD8 + in VTE group were more significant than those in the infected group and the combined group. At the same time, the author observed the CD values of the four groups were too low, normal and too high proportion, parallel χ2 value test and found that the control group compared with the other three groups were statistically significant, mainly in the CD3 ~ + and CD8 ~ + T cells increased the proportion of increased; CD4 ~ + / CD8 ~ + increased significantly increased. Except for the control group, there were slight differences between the 3 groups except for VTE group and CD3 + T cells in infected group (P = 0.043), while the other groups showed no significant difference (P> 0.05). The inflammatory factor hsCRP in the VTE group, the combined group, the infection group were significantly higher. CONCLUSION: Immune dysfunction is found in both VTE and infected patients. However, most patients with VTE have combined infection. In this study, we found that T lymphocyte subsets in VTE patients are independent of infection and lead to T cell immune dysfunction, suggesting that there is T cell immune dysfunction in VTE patients. VTE patients overall decline in T cell recognition antigen and transduction activation signal function, while T cells directly kill virus microorganisms significantly decreased the role of inflammation and immune mechanisms involved in the development of venous thrombosis.