淋巴细胞亚群在肾移植术后巨细胞病毒感染患者中的表达及意义

摘要

目的 探讨肾移植受者巨细胞病毒(cytomegalovirus,CMV)发生活动性感染时,其外周血淋巴细胞亚群的表达及其临床意义.方法 2010年1月～2011年12月期间确诊CMV抗原阳性的肾移植受者(n=50),根据感染源不同分为CMV感染组(n=13)和并发感染组(n=37),对照组为无感染的肾功能稳定的肾移植受者(n=10).利用免疫荧光技术进行CMV抗原检测,采用流式细胞术检测上述样本的淋巴细胞亚群.结果 CMV感染组与并发感染组的CD3+T淋巴细胞含量分别为(68.6±8.64)%和(61±21.74)%,与肾移植稳定组(72.9±8.64)%相比,差异无统计学意义(P＞0.05);CMV感染组与并发感染组的CD4+T淋巴细胞含量分别为(23.8±0.75)%和(21.85±8.83)%,与肾移植稳定组(50.8±10.35)%相比均减少,差异有统计学意义(t值分别为8.232 8,8.873 2,P值均＜0.05);CMV感染组与并发感染组的CD8+T淋巴细胞含量分别为(39.2±1.53)%和(36.2±15.1)%,与肾移植稳定组(20.6±7.56)%相比均增加,差异有统计学意义(t值分别为7.6605,3.235,P值均＜0.05);CMV感染组与并发感染组的CD4+/CD8+比值分别为(0.63±0.11)和(0.69±0.18),与肾移植稳定组(2.25±0.58)相比明显降低,差异有统计学意义(t值分别为5.988 5,8.396 9,P值均＜0.05).CMV感染组与并发感染组的B细胞含量分别为(10.2±3.43)%和(11.8±20.9)%,与肾移植稳定组(8.9±2.07)%相比,差异均无统计学显著性意义(P＞0.05).CMV感染组和并发感染组的NK细胞含量分别为(8.01±2.5)%和(7.2±1±0.14)%,与肾移植稳定组(15.4±7.9)%相比均明显降低,差异有统计学意义(t值分别为2.850 4,2.363 8,P值＜0.05).结论 采用流式细胞术测定淋巴细胞亚群并动态监测其变化,对于早期诊断和鉴别诊断重症CMV感染以及合理应用免疫抑制剂有一定的指导意义.%Objective To explore cytomegalovirus(CMV) infection in renal transplant recipients of the body lymphocyte sub sets expression and significance. Methods From January 2010 to December 2011 cytomegalovirus antigen positive renal transplant recipients (n=50) ,according to the virus and bacteria fungi infection status was divided into pure CMV infection group (n=13),intercurrent infection group (n=37) ,control group for renal normal renal transplants (n=10).The HCMV pp65 antigen tested via immune fluorescence assay,lymphocyte subsets of the samples was detectedby flow cytometry. Results The CD3+ lymphocyte in the CMV infection group and intercurrent infection group were (68. 6 + 8. 64)% and (61 ± 21. 74) % respectively. There were no significant differences compared with renal transplantation stable group (P>0. 05). The CD4+ lymphocyte of them were (23. 8 ± 0. 75) % and (21. 85 ± 8. 83) % respectively,and the difference had statistical significance compared with renal transplantation stable group (t=8. 232 8,8. 873 2, P<0. 05). The CD8+ lymphocyte in the CMV infection group and intercurrent infection group were (39. 2 ± 1. 53) % and (36. 2 ± 15. 1) % respectively,and the difference had statistical significance compared with renal transplantation stable group (t=7. 660 5 ,3. 23 5, P<0. 05). The CD4 + /CD8+ of them were (0. 63 ± 0. 11) and (0. 69 ± 0. 18) respectively, and the difference had statistical significance (t = 5.988 5,8.396 9,P>0.05). The B cell in the CMV infection group and intercurrent infection group were (10.2 + 3.43)% and (11.8 ± 20. 9')% respectively,and there were no significant differences compared with renal transplantation sta ble group (P<0. 05). The NK of them were (8. 01 ± 2. 5) % and (7. 2 ± 10. 14) % respectively, and renaltransplantation stable group were significantiy lower than,their difference was statistically significant (t=2. 850 4,2. 363 8, P>0. 05). Conclusion By flow cytometry analyzer to measure lymphocyte subsets and dynamic monitoring the change,for early diagnosis and differential diagnosis of severe CMV infection and the reasonable application of immune inhibitors have certain guiding.