肺动脉血栓栓塞症患者的免疫学变化及在诊疗中的作用

发布时间：2018-07-02 11:25

本文选题：肺栓塞 + 免疫功能　；参考：《临床心血管病杂志》2016年09期

【摘要】：目的:明确免疫功能在肺动脉血栓栓塞症(pulmonary thromboembolism,PE)中的作用及为PE的防治提供新的诊疗思路。方法:选取在同济大学附属同济医院住院的PE患者70例(PE组),另选对照组20例。所有入选者均行下列检测:NYHA心功能分级,血生化指标,心电图,X线胸片,超声心动图,肺通气/灌注扫描或肺血管CT等;并通过流式细胞仪测定免疫细胞的表面分化抗原、补体及细胞因子等,同时随访各项指标变化。结果:PE组CD3、CD8显著降低(P0.05),CD4/CD8比值显著升高(P0.05),随访1或3个月和6个月时的D-二聚体和NYHA心功能与基础水平相比差异有统计学意义(均P0.05);同时随访6个月时的CD3、CD8和CD4/CD8比值与基础值相比差异有统计学意义(P0.05)。与对照组比较,PE组总补体、C3和C4、白细胞介素-6(interleukin-6,IL-6)均明显上升,差异有统计学意义(均P0.05)。随访发现仅IL-6出现显著变化(P0.05),CD3水平与NYHA心功能相关(P0.05),CD8水平和CD4/CD8比值与NYHA心功能、肺血管CTA、肌钙蛋白和pro-BNP相关。IL-6水平与肺血管CTA、肌钙蛋白相关(P0.05)。单因素logistic分析发现CD3水平、CD8水平和CD4/CD8比值差异有统计学意义。结论:T细胞免疫失衡在PE的发生、发展中作用显著,同时部分细胞因子和补体也可能起到了一定的作用。通过随访发现T细胞免疫功能随着病情的好转而得到改善。T细胞免疫功能指标与PE各项检测指标之间存在一定的相关性,提示部分T细胞表面分化抗原有望成为检测PE的有效指标。
[Abstract]:Objective: to clarify the role of immune function in pulmonary thromboembolism (PE) and to provide new diagnosis and treatment ideas for the prevention and treatment of PE. Methods: 70 cases of PE patients hospitalized in Tongji Hospital Affiliated to Tongji University (group PE) were selected and 20 cases were selected as the control group. All the participants were examined as follows: NYHA cardiac function classification, blood biochemical finger. Standard, electrocardiogram, X-ray chest film, echocardiography, pulmonary ventilation / perfusion scan or pulmonary vascular CT, etc., and measured the surface differentiation antigen, complement and cytokine of immune cells by flow cytometry, and followed up the changes of all indexes. Results: PE group CD3, CD8 significantly decreased (P0.05), CD4/CD8 ratio increased significantly (P0.05), followed up for 1 or 3 months and 6 There were significant differences in D- two polymer and NYHA cardiac function compared with basic level (all P0.05), and CD3, CD8 and CD4/CD8 ratios at the same time of 6 months were statistically significant (P0.05). Compared with the control group, the total complement of group PE, C3 and C4, the -6 (interleukin-6,) Study significance (all P0.05). Follow-up showed that only IL-6 had significant changes (P0.05), CD3 level was associated with NYHA cardiac function (P0.05). CD8 level and CD4/CD8 ratio were associated with NYHA cardiac function, pulmonary vascular CTA, troponin and pro-BNP related.IL-6 levels and cardiac troponin levels. The difference of D8 ratio has statistical significance. Conclusion: T cell immune imbalance has a significant role in the development of PE, while some cytokines and complement may also play a role. It is found that the immune function of T cells can improve the immune function of.T cells and the detection of PE with the improvement of the condition. A certain correlation suggests that some T cell surface differentiation antigens are expected to be effective indicators for detecting PE.
【作者单位】：同济大学医学院;同济大学附属同济医院心内科;
【基金】：国家自然科学基金面上项目(No:81370422);国家自然科学基金青年科学基金(No:81400347) 上海市科委重点项目课题(No:11411951400)
【分类号】：R563.5

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