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目的探讨严重发热伴血小板减少综合征病毒(SFTSV)感染过程中,外周血T淋巴细胞活化对血液细胞、组织损伤和疾病发展的影响。方法应用流式细胞术,动态定量监测严重发热伴血小板减少综合征(SFTS)患者外周血中T淋巴细胞表面CD69、HLA-DR、CD28和CTLA-4等表达水平,分析其细胞表面分子变化与血清酶学以及白细胞和血小板异常的关系。结果 SFTS患者T细胞活化分子CD69和HLA-DR在整个病程中表达水平明显增加(P<0.05);CD4+细胞表面CD28的表达在SFTSV感染早期明显减低,但随病程发展而逐渐回升至正常范围,而T细胞表面CTLA-4的高表达则出现在感染后的中晚期。SFTS患者病程中,血清ALT、AST和LDH、CK等均明显高于正常范围,并伴随着T细胞表面CD69、HLA-DR等活化分子下调和CTLA-4表达水平上调而逐步恢复正常;白细胞和血小板计数的最低值出现在病程初期,伴随着T细胞表面CD69、HLA-DR等活化分子下调和CTLA-4表达增加逐渐回升至正常范围。结论 T淋巴细胞的过度活化可能是组织损伤的主要因素之一,而CTLA-4高表达,则可能是对机体T淋巴细胞过度活化的一种负反馈调节,在SFSTV感染者的免疫应答调节中发挥重要作用。
Objective To investigate the effect of peripheral blood T lymphocyte activation on the development of blood cells, tissues and the development of diseases during the severe fever with thrombocytopenic syndrome virus (SFTSV) infection. Methods The expression of CD69, HLA-DR, CD28 and CTLA-4 on peripheral blood T lymphocytes in patients with severe fever and thrombocytopenic syndrome (SFTS) were quantitatively analyzed by flow cytometry. The changes of cell surface molecules and Serum enzyme and leukocyte and platelet abnormalities. Results The expressions of CD69 and HLA-DR in patients with SFTS were significantly increased (P <0.05). The expression of CD28 on CD4 + cells was significantly decreased in the early stage of SFTSV infection, but gradually recovered to the normal range with the progression of the disease. The high expression of T cell surface CTLA-4 appears in the late infection. Serum levels of ALT, AST, LDH and CK in patients with SFTS were significantly higher than the normal range, and gradually returned to normal with the down-regulation of CD69, HLA-DR and other activated molecules on the surface of T cells and the up-regulation of CTLA-4. The lowest value of platelet count appeared early in the course of disease. With the down-regulation of CD69, HLA-DR and other activated molecules on T cells and the increase of CTLA-4 expression, the platelet count gradually returned to the normal range. Conclusion T lymphocyte overexpression may be one of the major factors of tissue injury. However, the high expression of CTLA-4 may be a negative feedback regulation of T lymphocyte overexpression in the regulation of immune response in SFSTV infected patients Play an important role.