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目的 研究免疫学指标在严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者病程中的变化趋势及轻 重症患者各指标的差异。方法 收集12 91例SARS患者的临床资料,建立病历数据库,记录轻症及重症患者发病1～5周各周的白细胞(WBC)计数,淋巴细胞计数,CD3+ 、CD4 + 及CD8+ T淋巴细胞绝对值,C3、C4、血沉(ESR)及C反应蛋白(CRP)等数据,研究各免疫学及炎性指标在轻重症SARS患者中的不同及意义。结果 SARS患者的淋巴细胞数、CD8+ T细胞绝对值在发病初期即达到最低值,随病程的进展缓慢回升,CRP、C4在发病初期即维持较高水平,随时间的进展缓慢下降,重症患者淋巴细胞水平及CD8+ T细胞绝对值明显低于轻症患者(P <0 .0 1) ,而CRP、C4水平明显高于轻症患者(P <0 .0 1)。结论 淋巴细胞,CD8+ T细胞绝对值及CRP、C4等免疫炎性指标均可作为评价病情轻重及变化的基本指标用于指导临床诊断及治疗。
Objective To study the change tendency of immunological indexes in the course of patients with severe acute respiratory syndrome (SARS) and the differences of various indexes in patients with severe and severe diseases. Methods The clinical data of 12 91 SARS patients were collected. The medical record database was established. The WBC count, lymphocyte count, CD3 +, CD4 + and CD8 + T lymphocyte absolute , C3, C4, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to study the difference and significance of immunological and inflammatory markers in severe and severe SARS patients. Results The absolute value of lymphocytes and CD8 + T cells in SARS patients reached the lowest value at the early stage of disease, slowly rose with the progress of disease course. CRP and C4 maintained a relatively high level in the early stage of disease and slowly decreased with the progress of time. The cell level and the absolute value of CD8 + T cells were significantly lower than those of mild cases (P <0.01), while the levels of CRP and C4 were significantly higher than those of mild cases (P <0.01). Conclusions The absolute value of lymphocytes and CD8 + T cells as well as the immunopathological indexes of CRP and C4 can be used as the basic index to evaluate the severity and change of disease.