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目的 研究严重急性呼吸综合征 (SARS)患者临床免疫学和病毒学特点 ,研究SARS发病的免疫学相关的机制 ,并评价其与病程的关系。方法 我们随机选择 3 3例SARS患者 ,对他们临床发病全过程进行了观察 ,并应用流式细胞技术、PCR方法、ELISA等方法 ,对患者的外周血T细胞亚群、DC细胞亚群、应用RT PCR和ELISA方法对血浆中病毒的基因和抗体进行了动态分析。并分析患者发病过程中上述免疫学指标的动态变化及其与SARS病程进展之间的关系。同时对 2 5名健康志愿者进行检测 ,以分析相关的数据作为对照。结果 与健康人群相比 ,进展期的轻症SARS患者外周血CD4T淋巴细胞、CD8T淋巴细胞和自然杀伤 (NK )细胞水平分别为 0 .3 67± 0 .3 0 5、0 .3 12±0 .2 77、0 .2 0 7± 0 .159。重症患者分别为 0 .2 62± 0 .175、0 .2 3 2± 0 .184、0 .189± 0 .157。特别显著的是SARS发病过程中I型树突状细胞 (DC1)和Ⅱ型树突状细胞 (DC2 )数量降低幅度最大 ,轻症患者DC1和DC2细胞数量分别为 1.3± 0 .5、1.0± 0 .2 ,而重症患者外周血的DC2为 0 .0 56± 0 .0 7。在恢复期 ,外周血中的CD4和CD8淋巴细胞接近正常水平的 80 %～ 85%之间 ,但是NK细胞仅为正常水平的65%左右。而DC1细胞上升的幅度最大 ,到第 7周达到 2 0 .461± 2 .59
Objective To study the clinical immunology and virological characteristics of patients with severe acute respiratory syndrome (SARS), study the immunological related mechanism of SARS and evaluate its relationship with the course of disease. Methods We randomly selected 33 SARS patients and observed the whole course of their clinical development. We used the methods of flow cytometry, PCR and ELISA to detect the expression of T cell subsets and DC subsets in peripheral blood RT-PCR and ELISA methods for the dynamic analysis of genes and antibodies in the plasma of the virus. And analyze the dynamic changes of the above immunological indexes during the pathogenesis of the patients and their relationship with the progress of SARS. At the same time, 25 healthy volunteers were tested to analyze the relevant data as a control. Results The levels of CD4 T lymphocytes, CD8 T lymphocytes and natural killer (NK) cells in peripheral blood of patients with advanced SARS were significantly lower than those of the healthy controls (0.337 ± 0.305,0.312 ± 0 .2 77,0 .2 0 7 ± 0 .159. Severe patients were 0.222 ± 0 .175,0 .232 ± 0.184,0 .189 ± 0.157. Particularly, the number of dendritic cells (DC1) and type II dendritic cells (DC2) in SARS decreased most significantly during the pathogenesis of SARS. The number of DC1 and DC2 cells in patients with mild disease were 1.3 ± 0.5 and 1.0 ± 0 .2, and DC2 in peripheral blood of critically ill patients was 0. 56 ± 0. 0 7. During recovery, CD4 and CD8 lymphocytes in the peripheral blood range between 80% and 85% of normal, but only about 65% of normal NK cells. DC1 cells increased the most, reaching 20.461 ± 2.59 at the 7th week