CAJ | 학술논문

目的：探讨外周血淋巴细胞亚群对儿童噬血细胞性淋巴组织细胞增生症（HLH）诊断、治疗和预后判断的意义。方法30例HLH患儿，采用HLH-2004诊断治疗方案，20例患儿获得完全缓解，10例死亡。30例同龄健康儿童作为正常对照。采用流式细胞术检测外周血淋巴细胞亚群。结果20例缓解患儿和10例死亡患儿急性期与正常对照组比较，CD3+T和CD8+T细胞比例均增高，CD4+T和CD3-CDl6+CD56+NK细胞比例均下降，CD4+/CD8+比值减低，差异均有统计学意义（H=7.857~45.448，P均<0.05）；CD19+B细胞比例与对照组比较，差异无统计学意义（H=6.202， P>0.05）。20例HLH缓解患儿缓解期与急性期淋巴细胞亚群比较，CD3-CD16+CD56+NK细胞比例的差异有统计学意义（Z=3.760，P<0.05），CD3+T、CD8+T、CD4+T和CD4+/CD8+比值、CD19+B计数差异无统计学意义(Z=0.135~1.082，P均＞0.05)。结论 HLH患儿淋巴细胞亚群有明显变化，存在细胞免疫失衡；动态检测其变化可能有助于判断HLH的治疗效果及预后。
목적：탐토외주혈림파세포아군대인동서혈세포성림파조직세포증생증（HLH）진단、치료화예후판단적의의。방법30례HLH환인，채용HLH-2004진단치료방안，20례환인획득완전완해，10례사망。30례동령건강인동작위정상대조。채용류식세포술검측외주혈림파세포아군。결과20례완해환인화10례사망환인급성기여정상대조조비교，CD3+T화CD8+T세포비례균증고，CD4+T화CD3-CDl6+CD56+NK세포비례균하강，CD4+/CD8+비치감저，차이균유통계학의의（H=7.857~45.448，P균<0.05）；CD19+B세포비례여대조조비교，차이무통계학의의（H=6.202， P>0.05）。20례HLH완해환인완해기여급성기림파세포아군비교，CD3-CD16+CD56+NK세포비례적차이유통계학의의（Z=3.760，P<0.05），CD3+T、CD8+T、CD4+T화CD4+/CD8+비치、CD19+B계수차이무통계학의의(Z=0.135~1.082，P균＞0.05)。결론 HLH환인림파세포아군유명현변화，존재세포면역실형；동태검측기변화가능유조우판단HLH적치료효과급예후。
ObjectiveTo explore the role of the lymphocyte subsets in the peripheral blood in diagnosis, treatment and prognosis of hemophagocytic lymphohistiocytosis (HLH) in children.MethodA total of 30 children with HLH were enrolled in this study and treated according to the HLH-2004 diagnostic guidelines. 20 children with HLH entered complete remission (CR) and 10 children with HLH died. Thirty age-matched healthy children were selected as normal controls. T cell subsets in the pe-ripheral blood were measured by lfow cytometry.ResultsCompared with control group, CD3+T and CD8+T cells were signiif-cantly increased, CD4+T and CD3-CDl6+CD56+ NK cells were signiifcantly decreased, and CD4+/CD8+ cell ratio was signiifcantly decreased in 20 CR children and 10 died children with HLH in acute phase (P<0.05). CD19+B cells was not statistically different in 20 CR children and 10 died children with HLH in acute phase from control group (P>0.05). In acute phase, the lymphocyte subsets were not statistically different between 20 CR children and 10 died children (P>0.05). In 20 CR children, the proportion of CD3-CD16+CD56+NK in CR phase was statistically different than that in acute phase (P<0.05).ConclusionsChildren with HLH have obvious changes in peripheral blood lymphocyte subsets and have cellular immunity disorders. Dynamic detection of the changes may help determine the therapeutic effect and prognosis of HLH.