监测外周血中性粒细胞和 T 淋巴细胞亚群有助于区分 2019 冠状病毒病的严重程度和疾病进展。
Monitoring peripheral neutrophil and T-lymphocyte subsets could assist in differentiating the severity and disease progression of coronavirus disease 2019.
机构信息
Department of Laboratory Medicine/Research Center of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Laboratory Medicine, Public Health Clinical Center of Chengdu, Chengdu, China.
出版信息
Aging (Albany NY). 2021 Mar 19;13(6):7723-7732. doi: 10.18632/aging.202701.
Helper T cells (CD3+CD4+ T cells) and cytotoxic T cells (CD3+CD8+ T cells) play direct and indirect antiviral roles. This study retrospectively explored the clinical significance of peripheral lymphocytes, especially the dynamic analysis of T-cell subsets, in determining coronavirus disease 2019 (COVID-19) severity and progression. Seventy-nine patients with COVID-19 in the Public Health Clinical Center of Chengdu from January to February 2020 were included, 59 of which were analyzed for dynamic peripheral T-cell subsets expression. The neutrophil to CD4+ T lymphocyte ratio (N4R) and neutrophil to CD3+ T lymphocyte ratio (N3R) showed clinical significance in differentiating severe or critically-severe COVID-19, with area under receiver operating characteristic curves (AUCs) of 0.933 and 0.900, respectively (P < 0.05). COVID-19 patients with more baseline peripheral lymphocytes or NK cells were prone to test negative to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after therapy (P < 0.05), and the AUC of NK cells for predicting negative results of SARS-CoV-2 RNA detection after therapy was 0.800. When the number of peripheral CD3+CD4+ and CD3+CD8+ T cells in COVID-19 patients continuously increased 6-9 days after baseline, the period of disease exacerbation could be delayed for more than 2 weeks after admission. Baseline N4R and N3R could be potential biomarkers for assisting in differentiating COVID-19 severity, and dynamically monitoring peripheral CD3+CD4+ and CD3+CD8+ T cells 6-9 days after baseline could help clinicians to evaluate disease progression in COVID-19 patients.
辅助性 T 细胞(CD3+CD4+T 细胞)和细胞毒性 T 细胞(CD3+CD8+T 细胞)发挥直接和间接的抗病毒作用。本研究回顾性探讨了外周血淋巴细胞,尤其是 T 细胞亚群的动态分析,在确定 2019 年冠状病毒病(COVID-19)严重程度和进展中的临床意义。纳入 2020 年 1 月至 2 月成都市公共卫生临床医疗中心的 79 例 COVID-19 患者,其中 59 例分析了外周血 T 细胞亚群的动态表达。中性粒细胞与 CD4+T 淋巴细胞比值(N4R)和中性粒细胞与 CD3+T 淋巴细胞比值(N3R)在区分重型或危重型 COVID-19 方面具有临床意义,曲线下面积(AUC)分别为 0.933 和 0.900(P<0.05)。COVID-19 患者基线外周淋巴细胞或 NK 细胞较多,治疗后更易 SARS-CoV-2 检测阴性(P<0.05),NK 细胞预测治疗后 SARS-CoV-2 RNA 检测阴性的 AUC 为 0.800。COVID-19 患者基线后 6-9 天外周 CD3+CD4+和 CD3+CD8+T 细胞数量持续增加时,发病加重期可延迟入院后 2 周以上。基线 N4R 和 N3R 可能是协助区分 COVID-19 严重程度的潜在生物标志物,动态监测基线后 6-9 天外周 CD3+CD4+和 CD3+CD8+T 细胞有助于临床医生评估 COVID-19 患者的疾病进展。