吉林大学学报(医学版)  2018, Vol. 44 Issue (05): 1025-1029

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闫天懿, 安林, 李萍, 贾玉玺
YAN Tianyi, AN Lin, LI Ping, JIA Yuxi
慢性荨麻疹患者细胞免疫功能检测及其临床意义(附68例报告)
Detection of cellular immune function in patients with chronic urticaria and its clinical significance:A report of 68 cases
吉林大学学报(医学版), 2018, 44(05): 1025-1029
Journal of Jilin University (Medicine Edition), 2018, 44(05): 1025-1029
10.13481/j.1671-587x.20180525

文章历史

收稿日期: 2018-03-28
慢性荨麻疹患者细胞免疫功能检测及其临床意义(附68例报告)
闫天懿1 , 安林2 , 李萍1 , 贾玉玺2     
1. 吉林大学中日联谊医院风湿免疫科, 吉林 长春 130033;
2. 吉林大学中日联谊医院皮肤科, 吉林 长春 130033
[摘要]: 目的: 探讨细胞免疫在慢性荨麻疹发病中的作用,阐明慢性荨麻疹发生的免疫学机制。方法: 选取慢性荨麻疹患者68例和健康对照者70名作为研究对象,根据不同并发症将慢性荨麻疹患者分为4个不同亚组,分别为自身免疫性疾病组11例(类风湿3例、红斑狼疮2例、甲状腺疾病4例、白癜风2例)、幽门螺旋杆菌感染组13例、乙肝和丙肝感染组10例、肿瘤组6例和无并发症组28例。采用流式细胞术检测各组研究对象外周血T细胞亚群表面标志CD3+、CD4+和CD8+的表达情况,检测不同并发症慢性荨麻疹患者外周血T淋巴细胞亚群。结果: 与对照组比较,慢性荨麻疹组患者外周血中CD4+T淋巴细胞比例明显降低(P < 0.05),CD8+比例升高(P < 0.05),CD4+/CD8+比值下降(P < 0.05),CD3+比例无明显变化(P>0.05);与病程≤ 12个月慢性荨麻疹患者比较,病程>12个月慢性荨麻疹患者外周血中CD4+淋巴细胞比例明显降低(P < 0.05),CD8+比例升高(P < 0.05),CD4+/CD8+比值下降(P < 0.05),CD3+比例无明显变化(P>0.05);与无并发症组患者比较,有并发症慢性荨麻疹组患者外周血中CD4+和CD3+比例亦降低(P < 0.05),CD8+比例升高(P < 0.05),CD4+/CD8+比值下降(P < 0.05)。结论: 慢性荨麻疹患者体内存在细胞免疫功能异常,尤其CD4+细胞的比例降低可能是疾病发生发展的机制之一。
关键词: 慢性荨麻疹    细胞免疫    体液免疫    变态反应    
Detection of cellular immune function in patients with chronic urticaria and its clinical significance:A report of 68 cases
YAN Tianyi1, AN Lin2, LI Ping1, JIA Yuxi2     
1. Department of Rheumatic Immunity, China-Japan UnionHospital, Jilin University, Changchun 130033, China;
2. Department of Dermatology, China-Japan UnionHospital, Jilin University, Changchun 130033, China
[Abstract]: Objective: To study the effect of cellular immune in the pathogenesis of chronic urticaria, and to clarify the immunological mechanism of chronic urticaria. Methods: A total of 68 patients with chronic urticaria and 70 normal controls were selected as the subjects.The patients with chronic urticaria were divided into four different subgroups according to the different complications; there were 11 patients in autoimmune disease group (3 case of rheumatism, 2 case of lupus erythematosus, 4 cases of thyroid diseases, 2 cases vitiligo), 13 patients in Helicobacter pylori infection group, 10 patients in hepatitis B and hepatitis C group, and 6 patients in tumor group. The expressions of T cell surface markers CD3+, CD4+, and CD8+ in the peripheral blood were detected with flow cytometry. Furthermore, the T cell subsets in the peripheral blood of the patients with chronic urticaria with different complications were detected by flow cytometry. Results: Compared with control group, the ratio of CD4+ T cells of the patients in chronic urticaria group was significantly decreased (P < 0.05), the ratio of CD8+ T cells was increased(P < 0.05), and the ratio of CD4+ T cells/CD8+ T cells was decreased (P < 0.05);but the ratio of CD3+ T cells had no changes (P>0.05).Compared with the patients with the disease duration less than 12 months, the ratio of CD4+ T cells of the patients with the disease duration more than 12 months was significantly decreased (P < 0.05), the ratio of CD8+ T cells was increased(P < 0.05), and the ratio of CD4+/CD8+ was decreased (P < 0.05); but the ratio of CD3+ T had no changes (P>0.05).Compared with the patients without complications, the ratios of CD4+T cells and CD3+ T cells of the patients with complications were decreased (P < 0.05), the ratio of CD8+ T cells was increased(P < 0.05), and the ratio of CD4+/CD8+ was decreased (P < 0.05). Conclusion: The unbalance of cellular immune exists in the patients with chronic urticaria, especially the decreasing of the ratio of CD4+ T cells in peripheral blood of the patients might be one of the mechanisms of pathogenesis of chronic urticaria.
Key words: chronic urticaria     cellular immunity     humoral immunity     allergic reaction    

慢性荨麻疹是临床上常见的疾病,其病因及发病机制复杂, 与多种内外因素相关,如食物、药物、吸入物、物理因素及系统疾病等均可能是荨麻疹的诱发因素[1-3]。由于该病缺乏有效的治疗手段,严重影响患者的生活质量,近年来,关于荨麻疹发生机制及治疗研究已成为国内外学者的研究热点。既往研究[4-6]表明:荨麻疹的发生不仅与IgE介导的体液免疫有关,也有细胞免疫的参与,荨麻疹与Th17/Th1细胞和Tc17/Tc1比例失调相关[4],但目前有关伴有并发症的慢性荨麻疹患者CD4+T、CD8+T和CD3+T淋巴细胞的数量及比例的研究尚未见国内外文献报道。为进一步探讨T淋巴细胞在慢性荨麻疹发病机制中的作用,阐明慢性荨麻疹发生的免疫学机制,本文作者采用流式细胞术检测分析68例慢性荨麻疹患者外周血T淋巴细胞亚群的表达情况,并进一步研究伴有不同并发症慢性荨麻疹患者外周血T淋巴细胞亚群的改变情况。

1 资料与方法 1.1 研究对象

选择本院2017年1—2月68例慢性荨麻疹门诊患者作为研究对象。慢性荨麻疹纳入标准:①皮肤突然出现大小不等、形状不一的风团,境界清楚,皮疹此起彼伏,伴瘙痒,消退后不留痕迹,反复发作6周以上;②年龄18岁以上,符合慢性荨麻疹诊断标准[7]。排除标准:①妊娠、哺乳期妇女;②物理性荨麻疹及特殊类型荨麻疹;③过去1个月内应用抗组胺药物、免疫调节剂或糖皮质激素的患者。68例患者中,男性30例,女性38例;年龄18~79岁,平均年龄(51.7±6.34)岁,病程2月~12年,平均病程(31.6±15.4)个月。并发自身免疫性疾病11例(类风湿3例、红斑狼疮2例、甲状腺疾病4例、白癜风2例),并发幽门螺旋杆菌感染13例,并发乙肝和丙肝感染10例,并发肿瘤6例,无并发症患者28例。对照组为健康体检者70名,其中男性32名,女性38名;年龄20~76岁,平均年龄(49.9±5.99)岁。2组研究对象年龄和性别构成比等基本资料比较差异无统计学意义(P>0.05),具有可比性。本研究已通过吉林大学中日联谊医院伦理委员会审批且所有受试者均对本研究知情同意并签署知情同意书。

1.2 试剂和主要仪器

CD3、CD4和CD8细胞试剂购自美国BD公司。Cytomics FC500流式细胞仪为美国Becton Dickinson公司产品,LD4-2A(I)型离心机为北京京立公司产品。

1.3 流式细胞术检测患者外周血T淋巴细胞亚群

采集各组研究对象外周血(肝素抗凝)2mL, 检测方法严格按试剂说明书操作,分离淋巴细胞, 采用MultiSET软件上机,检测CD4+T、CD8+T和CD3+T淋巴细胞的数量及比例,计算CD4+/CD8+比值。

1.4 统计学分析

采用SPSS 22.0统计软件进行统计学分析。T淋巴细胞亚群百分比以x±s表示,采用F检验判断方差齐性, 方差齐同的2组样本均数比较采用两独立样本t检验, 方差不齐同的2组样本比较采用秩和检验。以P < 0.05为差异有统计学意义。

2 结果 2.1 慢性荨麻疹组和正常对照组研究对象外周血T细胞亚群

与对照组比较,慢性荨麻疹组患者外周血中CD4+T淋巴细胞比例明显降低(t=-15.239,P < 0.01),CD8+T淋巴细胞比例升高(t=8.519,P=0.001),CD4+/CD8+比值下降(t=-9.545,P=0.001),CD3+T淋巴细胞比例无明显变化(t=1.475,P=0.142)。见表 1

表 1 2组研究对象外周血T淋巴细胞亚群比例 Table 1 Ratios of T cell subsets in peripheral blood of subjects in two groups
(x±sη/%)
Group n CD4+ CD8+ CD4+/CD8+ CD3+
Control 70 43.82±6.88 22.05±5.99 1.97±0.31 60.15±3.98
Chronic urticaria 68 25.25±7.43* 31.67±7.23* 1.02±0.77* 59.02±4.95
* P < 0.01 compared with control group.
2.2 不同病程慢性荨麻疹患者外周血T淋巴细胞亚群

与病程≤12个月慢性荨麻疹患者比较,病程>12个月慢性荨麻疹患者外周血CD4+T淋巴细胞比例明显降低(t=2.359,P=0.021),CD8+T淋巴细胞比例升高(t=-3.093,P=0.003),CD4+/CD8+比值下降(t=2.471,P=0.016),CD3+T淋巴细胞比例无明显变化(t=1.145,P=0.236)。见表 2

表 2 不同病程慢性荨麻疹患者T淋巴细胞亚群比例 Table 2 Ratios of T cell subsets in chronic urticara patients with different disease duration
(x±s, η/%)
Disease duration n CD4+ CD8+ CD4+/CD8+ CD3+
≤12 months 37 28.45±4.56 30.13±5.62 1.24±0.61 60.61±3.42
>12 months 31 25.74±4.91* 34.29±5.38* 0.81±0.88* 59.48±4.22
* P < 0.05 compared with ≤12 months.
2.3 不同并发症慢性荨麻疹患者外周血T淋巴细胞亚群

与无并发症组慢性荨麻疹患者比较,并发幽门螺旋杆菌感染、血液病或恶性肿瘤、自身免疫病、乙肝/丙肝的慢性荨麻疹患者外周血中CD4+T淋巴细胞比例明显降低(t1= 4.060,P1<0.01;t2= 3.725,P2=0.001;t3= 5.756,P3<0.01;t4= 4.333,P4=0.001),CD8+T淋巴细胞比例明显升高(t1= -2.049,P1=0.047;t2=-3.199,P2=0.003;t3=-4.913,P3<0.01;t4= -3.484,P4=0.001),CD4+/CD8+比值下降(t1= 3.771,P1=0.001;t2= 2.721,P2=0.001;t3= 8.985,P3=0.001;t4=2.144,P4=0.013),CD3+T淋巴细胞比例明显降低(t1= 2.471,P1=0.001;t2=2.190,P2=0.036;t3=4.119,P3<0.01;t4= 2.835,P4=0.007)。见表 3

表 3 伴有不同并发症慢性荨麻疹患者T淋巴细胞亚群比例 Table 3 Ratios of T cell subsets in chronic urticarial patients with different complications
(x±s, η/%)
Complication n CD4+ CD8+ CD4+/CD8+ CD3+
No complication 28 28.71±4.20 29.25±5.39 1.23± 0.33 59.71±4.24
Autoimmune disease 11 20.52±2.63* 38.70±4.66* 0.75± 0.14* 54.09±2.43*
Helicobacter pylori infection 13 23.15±3.78* 32.84±4.84* 0.84±0.19* 57.02±2.71*
Hepatitis B and hepatitis C 10 22.72±2.83* 35.27±2.96* 0.93± 0.15* 55.70±2.26*
Tumor 6 22.16±1.47* 37.16±6.04* 0.83±0.29* 55.83±1.47*
* P<0.05 comparedwithno complication.
3 讨论

T淋巴细胞是介导细胞免疫应答的主要细胞,在人体免疫系统中扮演重要的角色,CD3分子在所有成熟T淋巴细胞表面表达,是成熟T淋巴细胞的标志。CD4+T淋巴细胞能够辅助B细胞和细胞毒性T淋巴细胞活化,并产生抗体使巨噬细胞激活,增加其提呈抗原及杀伤细胞内微生物的能力[8-9], CD8+T淋巴细胞为具有杀伤活性的细胞,能够通过分泌肿瘤坏死因子(TNF)颗粒酶和穿孔素等细胞因子杀伤靶细胞,介导靶细胞凋亡[10-11]。其中CD4+T细胞被提呈的抗原激活后, 能成熟并分化为2个不同的功能亚群:Th1和Th2,Th2细胞能够释放白细胞介素4、5和10等细胞因子,诱导B淋巴细胞及巨噬细胞的激活,引起IgE及组胺释放,发生炎症反应及超敏反应,导致慢性荨麻疹皮损的发生[12]。Th1细胞能够释放γ干扰素和白细胞介素12等细胞因子,减缓超敏反应的发生及Th细胞向Th2细胞分化,减轻慢性荨麻疹的临床症状[4, 13-14]。红斑狼疮、干燥综合征、风湿病、甲状腺炎和甲状腺功能亢进等自身免疫性疾病与慢性荨麻疹发生有密切关联[15-18], 提示免疫失衡可能是慢性荨麻症发生发展的关键因素之一。

本研究通过流式细胞术检测慢性荨麻疹患者外周血T淋巴细胞亚群的变化,结果显示:患者组CD3+T细胞比例与对照组比较差异无统计学意义,CD8+T细胞比例明显高于对照组,而CD4+T细胞比例和CD4+/CD8+比值明显低于对照组,提示慢性荨麻疹患者外周血免疫细胞功能失衡与疾病的发生有密切关系。本研究对不同病程慢性荨麻疹患者外周血T淋巴细胞亚群进行了分析,与病程≤12个月慢性荨麻疹患者比较,病程>12个月慢性荨麻疹患者外周血CD4+T淋巴细胞比例明显降低,CD8+T淋巴细胞比例升高,CD4+/CD8+比值下降,表明病程越长,患者的免疫功能失衡越严重。本研究结果显示:慢性荨麻疹伴有并发症的患者,尤其是并发自身免疫性疾病组患者,CD4+T淋巴细胞比例和CD4+/CD8+比值明显降低,CD8+T比例明显升高。关于并发结缔组织病患者出现的荨麻疹是自身免疫性疾病本身的皮肤表现,还是2种疾病共同的皮肤表现,还有待进一步的研究。慢性荨麻疹长期反复发作,逐渐增加机体对自身抗原的敏感性,可能改变了疾病自身的特点,增加了自身免疫的成分,使荨麻疹的发病具有自身免疫学的背景,进一步诱导细胞免疫功能紊乱,表明CD3+T淋巴细胞比例、CD4+T淋巴细胞比例、CD8+T淋巴细胞比例和CD4+/CD8+比值与慢性荨麻疹患者的临床特征有一定的关联。建议对病程较长及伴有并发症的慢性荨麻疹患者进行抗核抗体等免疫学指标的检测,以便早期发现并发存在的系统性自身免疫性疾病[19-20]

综上所述, T淋巴细胞亚群失衡与慢性荨麻疹发病机制有密切关联,对慢性荨麻疹患者进行T淋巴细胞检测,对评估病情、完善治疗方案以及预测预后具有一定的意义,本研究结果为慢性荨麻疹的临床治疗提供了新的思路。

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