感染性肺炎与免疫相关间质性肺病中淋巴细胞亚群的表达

Expression and clinical significance of lymphocyte subsets in infectious pneumonia and immune-related interstitial lung disease

摘要

目的：比较感染性肺炎和免疫相关间质性肺病（immune-related interstitial lung disease，IRILD）患者淋巴细胞亚群表达的差异，评估不同肺炎患者的免疫状态，从免疫学的角度为有效鉴别不同肺炎提供新的实验室指标。方法：连续纳入 2023 年1月至2024年3月就诊于北京大学人民医院风湿免疫科的感染性肺炎患者 27 例、单纯IRILD 患者 27 例以及 IRILD 合并感染患者 24 例，并选择同期进行体检的 50 名健康志愿者作为对照组。采用流式细胞术检测各组淋巴细胞亚群水平。结果：病例组与对照组间年龄差异无统计学意义（P>0.05）。在实验室指标方面，与 IRILD 组相比，感染性肺炎组患者中性粒细胞、C 反应蛋白、降钙素原（procalcitonin，PCT）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、D-二聚体、纤维蛋白原水平增高（P<0.05），IRILD 合并感染组患者 PCT、ESR、免疫球蛋白 G 水平增高（P<0.05）。在淋巴细胞亚群水平方面，与对照组相比，感染性肺炎组患者的 T、B、自然杀伤（natural killer，NK）、 CD4⁺T 细胞数， CD4⁺/CD8⁺比值明显降低（P<0.05），IRILD 组患者的 T、B，CD4  ⁺T 细胞数、 CD4⁺/CD8⁺比值明显降低（P<0.05），IRILD 合并感染组患者 T、 B、NK、CD4⁺T、CD8⁺T 细胞数明显降低（P<0.05）。与 IRILD 组患者相比，感染性肺炎组患者 NK 细胞数明显下降（P<0.05），IRILD 合并感染组患者NK、CD8⁺T 细胞数明显降低（P<0.05）。结论：不同肺炎淋巴细胞亚群水平存在一定差异，为有效鉴别不同肺炎提供了新的思路。

Abstract

Objective：To delineate differences in lymphocyte subset expression between patients with infectious pneumonia and immune-related interstitial lung disease（IRILD），to assess the immune status across distinct pneumonia types，and to provide novel laboratory markers through immunological profiling to effectively differentiate pneumonias. Methods：A total of 78 patients sequentially enrolled from Peking University People＇s Hospital between January 2023 and March 2024 were stratified into three groups： 27 with infectious pneumonia， 27 with isolated immune-related interstitial lung disease（IRILD），and 24 with IRILD complicated by infection.Fifty age-matched healthy individuals undergoing routine physical examinations during the same period served as controls.Peripheral lymphocyte subsets were quantified in all subjects by multiparametric flow cytometry. Results：There was no statistically significant difference in age between the pneumonia patients and the healthy control group in this study (P>0.05).Analysis of laboratory parameters revealed that compared with the IRILD group，the infectious pneumonia group demonstrated significantly elevated levels of neutrophils，C-reactive protein，procalcitonin（PCT），eryth- rocyte sedimentation rate（ESR），D-dimer，and fibrinogen (P<0.05) ，while the IRILD with superim- posed infection group exhibited significantly increased levels of PCT，ESR，and immunoglobulin G(P< 0.05）.At the lymphocyte subset level，compared with the control group，the infectious pneumonia group exhibited significantly decreased counts of T cells，B cells，natural killer（NK）cells，CD4  ⁺T cells，and the CD4⁺/CD8⁺ratio (P<0.05).Similarly，compared with the control group，the IRILD group showed significantly reduced counts of T cells，B cells， CD4⁺T cells，and the CD4⁺/CD8⁺ratio（P< 0.05）.Furthermore，compared with the control group，the IRILD-with-infection group demonstrated sig- nificantly lower counts of T cells，B cells，NK cells，CD4  ⁺T cells，and CD8  ⁺T cells（P<0.05）.Com- pared with the IRILD group，the infectious pneumonia group had a significantly lower NK cell count (P<0.05).Additionally，compared with the IRILD group，the IRILD-with-infection group displayed significantly reduced counts of NK cells and CD8  ⁺T cells (P<0.05). Conclusion：The study revealed significant variations in lymphocyte subset profiles among the distinct pneumonia groups，providing novel insights with potential diagnostic value for differentiating between pneumonia types.

关键词

感染性肺炎 / 免疫相关间质性肺病 / 淋巴细胞亚群

Key words

Infectious pneumonia / Immune-related interstitial lung disease / Lymphocyte subpopula- tions.

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