Mahmoudi Shima, Yaghmaei Bahareh, Sharifzadeh Ekbatani Meisam, Pourakbari Babak, Navaeian Amene, Parvaneh Nima, Haghi Ashtiani Mohammad Taghi, Mamishi Setareh
Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.
Division of Pediatric Intensive Care Unit, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Front Pediatr. 2021 Apr 14;9:643299. doi: 10.3389/fped.2021.643299. eCollection 2021.
While pathogenesis in COVID-19 is not fully known and the effects between SARS-CoV-2 and the immune system are complicated, it is known that lymphopenia, hyper-inflammatory responses, and cytokines play an important role in the pathology of COVID-19. While some hematological abnormalities have been described among the laboratory features of COVID-19, there have not been studies reported on lymphocyte subset analyses in children. The aim of this study was to describe lymphocyte subsets in pediatric patients with mild/moderate or severe COVID-19. The subjects in the study were children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia confirmed with the real-time RT-PCR. The subjects were admitted to the Children's Medical Center, affiliated with the Tehran University of Medical Sciences, between March 7 and June 10 of 2020. The complete blood counts and lymphocyte subpopulations were analyzed for each patient. The study included 55 hospitalized patients with confirmed SARS-CoV-2 infection (34 patients (62%) with an observed mild/moderate case of the disease and 21 patients (38%) with severedisease). Lymphocyte counts were found to be lower in patients with a severe case (mean ± SD 1.6 ± 0.9 in the severe group vs. 2.3 ± 2.2 in the mild group). Compared to the group with mild/moderate pneumonia, children with severe pneumonia had an increased count of CD8 T cell and a lower percentage of CD4 T cell. However, the differences between the groups were negligible. Interestingly, the severe group had a lower CD4/CD8 T cell ratio compared to the mild group (1.1 ± 0.47 vs. 1.4 ± 0.8, -value: 0.063). CD4/CD8 T cell ratio <2, 1.5, and 1 was found in 48 (87%), 40 (73%), and 19 cases (35%). All of the seven cases in which the subject passed (13%) had CD4/CD8 T cell ratio of <2, 86% had CD4/CD8 T cell ratio of <1.5, and 29% had CD4/CD8 T cell ratio of <1. The CD4/CD8 T cell ratio was lower in patients with severe COVID-19 compared to those with mild/moderate form of disease. However, although a decline in CD4/CD8 ratio may serve as a useful metric in analyzing of the derangement in immune responses in patients with severe COVID-19, further study with larger sample sizes is highly recommended.
虽然新冠病毒病（COVID-19）的发病机制尚未完全明确，且严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与免疫系统之间的相互作用较为复杂，但已知淋巴细胞减少、过度炎症反应和细胞因子在COVID-19的病理过程中起重要作用。虽然在COVID-19的实验室检查特征中已描述了一些血液学异常，但尚未有关于儿童淋巴细胞亚群分析的研究报道。本研究的目的是描述轻度/中度或重度COVID-19患儿的淋巴细胞亚群。本研究的受试者为经实时逆转录聚合酶链反应（RT-PCR）确诊的SARS-CoV-2肺炎患儿。这些受试者于2020年3月7日至6月10日入住德黑兰医科大学附属儿童医院。对每位患者进行全血细胞计数和淋巴细胞亚群分析。该研究纳入了55例确诊SARS-CoV-2感染的住院患者（34例（62%）为观察到的轻度/中度病例，21例（38%）为重度病例）。发现重度病例患者的淋巴细胞计数较低（重度组平均±标准差为1.6±0.9，轻度组为2.3±2.2）。与轻度/中度肺炎组相比，重度肺炎患儿的CD8 T细胞计数增加，CD4 T细胞百分比降低。然而，两组之间的差异可忽略不计。有趣的是，重度组的CD4/CD8 T细胞比值低于轻度组（1.1±0.47对1.4±0.8，P值：0.063）。48例（87%）、40例（73%）和19例（35%）患者的CD4/CD8 T细胞比值分别<2、<1.5和<1。所有7例死亡病例（13%）中，CD4/CD8 T细胞比值<2的占86%，<1.5的占29%，<1的占29%。与轻度/中度COVID-19患者相比，重度COVID-19患者的CD4/CD8 T细胞比值较低。然而，尽管CD4/CD8比值下降可能是分析重度COVID-19患者免疫反应紊乱的一个有用指标，但强烈建议进行更大样本量的进一步研究。
