噬血细胞综合征患者中EBV感染状态及免疫功能评价

发布时间：2018-06-07 14:09

本文选题：噬血细胞综合征 + EBV感染　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:探索噬血细胞综合征患者中EBV感染患者的临床特点,并且评价此类患者的免疫功能状态。方法:回顾性分析我院2012年1月至2016年12月住院治疗的符合入选及排除标准的298例成人噬血细胞综合征患者的临床资料和相关免疫学指标。将血EBV-DNA500 copies/ml定义为EBV感染阳性。使用SPSS19.0软件,比较EBV感染患者和非EBV感染患者的临床特点和免疫学差异,并比较EBV-DNA滴度水平和各临床指标是否有相关性。结果:EBV阳性噬血细胞综合征患者和EBV阴性噬血细胞综合征患者比较,肿瘤发生率显著升高(p=0.019)、死亡率升高(46.67%vs 34.97%)。同时血小板显著减低(73.65±55.65 vs 113.41±108.57,p=0.041),APTT时间显著延长(49.28±15.50 vs 37.70±13.97,p=0.000),总胆固醇显著减低(3.32± 1.23 vs 4.14±1.68,p=0.013),低密度脂蛋白显著减低(1.73±0.85 vs 2.18±1.09,p=0.040),铁蛋白升高幅度显著偏低(8536.23±10688.0 vs 15504.46±199446.73,p=0.048)。免疫学方面,EBV阳性噬血细胞综合征患者补体C4更高(0.26±0.09 vs 0.21±0.10,p=0.018),CD3+T细胞计数显著减低(525.48±445.69 vs 865.85±839.89,p=0.041),CD8+T细胞计数显著减低(238.13±264.34 vs 539.51 ±774.84,p=0.035),CD4/CD8比值显著升高(1.70± 1.79 vs 0.91 ±0.98,p=0.023)。相关性分析发现,APTT和EBV-DNA滴度水平呈正相关(R=0.476,p=0.000);PT和EBV-DNA滴度水平呈正相关(R=0.218,p=0.007);总胆红素和EBV-DNA滴度水平呈正相关(R=0.223,p=0.033);直接胆红素和EBV-DNA滴度水平呈正相关(R=0.288,p=0.005);低密度脂蛋白和EBV-DNA滴度水平呈负相关(R=-0.219,p=0.046);免疫指标方面CD8+T细胞水平和EBV-DNA滴度水平呈负相关关系(R=-0.359,p=0.002);CD4/CD8水平和EBV-DNA滴度水平呈正相关关系(R=0.402,p=0.000);补体C4和EBV-DNA滴度水平呈正相关(R=0.418,p=0.000)。结论:噬血细胞综合征患者中EBV感染患者的临床指标具有鲜明的临床特点,有更高的肿瘤发生率、更高的死亡率。同时在免疫功能状态方面,EBV感染患者有明显减低的CD3+T细胞和CD8+T细胞计数和更高的补体C4,且CD8+T细胞计数和补体C4都与EBV-DNA滴度显著相关。且EBV在噬血细胞综合征患者的肝脏功能损害中有可能发挥了重要作用。
[Abstract]:Aim: to investigate the clinical features of EBV infection in patients with hemophagocytic syndrome and to evaluate their immune function. Methods: the clinical data and immunological indexes of 298 adult hemophagocytic syndrome patients who were admitted to hospital from January 2012 to December 2016 were analyzed retrospectively. Blood EBV-DNA500 copies/ml was defined as positive for EBV infection. SPSS19.0 software was used to compare the clinical characteristics and immunological differences between EBV infected patients and non-EBV infected patients, and to compare the correlation between the titer of EBV-DNA and the clinical indexes. Results compared with the patients with EBV negative hemophagocytic syndrome, the incidence of tumor was significantly increased in patients with hematophagocytic syndrome and the mortality was increased by 46.67 vs 34.97m. At the same time, there was a significant decrease in platelet count (73.65 卤55.65 vs 113.41 卤108.57), a significant prolongation of the APTT time (49.28 卤15.50 vs 37.70 卤13.97), a significant decrease in total cholesterol (3.32 卤1.23 vs 4.14 卤1.68p0.013), a significant decrease in low density lipoprotein (LDL-C) 1.73 卤0.85 vs 2.18 卤1.09p0. 04040, and a significant decrease in ferritin (8536.23 卤10688.0 15504.46 卤199446.3p0.048). In immunology, the number of complement C4 was significantly higher in patients with EBV-positive hemophagocytic syndrome (0.26 卤0.09 vs 0.21 卤0.10p0.018). The number of CD3 T cells decreased significantly (525.48 卤445.69 vs 865.85 卤839.89.89) p0.041T cell count. The CD4CD8 ratio in patients with EBV-positive hemophagocytic syndrome was significantly decreased by 238.13 卤264.34 vs 539.51 卤774.84p0.035% CD4CD8 / T cell ratio was significantly increased by 1.70 卤1.79 vs 0.91 卤8p0.02.923. The results of correlation analysis showed that there was a positive correlation between the titer of EBV-DNA and the titer of EBV-DNA. The titer of PT and EBV-DNA was positively correlated with the titer of EBV-DNA, the total bilirubin and the titer of EBV-DNA were positively correlated with the titer of EBV-DNA, the titer of EBV-DNA was positively correlated with the titer of EBV-DNA, the low density lipoprotein and EBV-DNA titer were positively correlated with the titer of EBV-DNA. There was a negative correlation between CD8 T cell level and EBV-DNA titer, a positive correlation between CD4 / CD8 level and EBV-DNA titer level, and a positive correlation between complement C4 titer and EBV-DNA titer level. Conclusion: the clinical indexes of EBV infection patients with hemophagocytic syndrome have distinct clinical characteristics, higher tumor incidence and higher mortality. At the same time, the number of CD3 T cells and CD8 T cells and the higher complement C4 were significantly decreased in the patients with EBV infection, and the CD8 T cell count and complement C4 were significantly correlated with the EBV-DNA titer. EBV may play an important role in hepatic dysfunction in patients with hemophagocytic syndrome.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.2

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