外周血T细胞CD38和HLA-DR的表达水平在儿童传染性单核细胞增多症中的临床意义

摘要 目的：探讨传染性单核细胞增多症（IM）患儿外周血T细胞活化分子CD38和人类白细胞抗原DR（HLA-DR）表达水平的临床意义。方法：采用流式细胞术分别检测45例IM患儿急性期和恢复期的活化分子CD38和HLA-DR在T细胞的表达水平，并与30例健康体检儿童进行对比。分析IM患儿急性期CD38和HLA-DR在T细胞的表达水平与EB病毒载量、肝功能指标、外周血异型淋巴细胞比例、淋巴细胞计数的相关性，并采用ROC曲线分析CD8⁺CD38⁺T和CD8⁺HLA-DR+T细胞百分比的诊断效能。结果：与对照组比较，IM急性期患儿的CD38和HLA-DR在T细胞的表达水平显著升高（P＜0.05）。CD8⁺CD38⁺T、CD8⁺HLA-DR+T细胞百分比分别与EBV-DNA、ALT、AST、LDH、异型淋巴细胞百分比、淋巴细胞计数呈正相关（P＜0.05），与白蛋白（ALB）呈负相关（P＜0.05）；CD4⁺CD38⁺T、CD4⁺HLA-DR+T细胞百分比与上述指标无显著相关性（P均＞0.05）。IM恢复期CD38和HLA-DR在T细胞的表达水平较急性期明显降低（P＜0.05）。ROC曲线分析CD8⁺CD38⁺T、CD8⁺HLA-DR+T细胞百分比显示诊断儿童IM的AUC值分别为0.931和0.993，特异度均为100%，灵敏度分别为88.89 %和93.33 %。结论：流式法检测CD38和HLA-DR在T细胞的变化有助于判断病情变化。外周血CD8⁺CD38⁺T、CD8⁺HLA-DR+T细胞百分比不仅能反映出IM急性期肝功能损伤严重程度，还可作为儿童IM的流式诊断指标。

Clinical Significance of CD38 and HLA-DR Expression in Peripheral Blood T cells in Children with Infectious Mononucleosis

ABSTRACT Objective: To investigate the clinical significance of the expression of peripheral blood T cell activation molecule CD38 and human leukocyte antigen DR (HLA-DR) in children with infectious mononucleosis (IM). Methods: Flow cytometry was used to detect the expression of activation molecules CD38 and HLA-DR in T cells in 45 children with IM during the acute phase and recovery phase, and the clinical data was compared with 30 healthy children. The correlation between the expression of CD38 and HLA-DR in T cells during the acute phase of children with IM and EB virus load, liver function indexes, the proportion of atypical lymphocytes in peripheral blood, and lymphocyte count were analyzed, and the ROC curve was used to analyze the CD8⁺CD38⁺ diagnostic efficacy of T and CD8⁺HLA-DR+T cell percentages. Results: Compared with the control group, the expression of CD38 and HLA-DR in T cells of children with IM in the acute phase were increased(P<0.05). The percentages of CD8⁺CD38⁺T and CD8⁺HLA-DR+T cells were positively correlated with EBV-DNA, ALT, AST, LDH, percentage of atypical lymphocytes, and lymphocyte counts, respectively(P<0.05), however, negatively correlated with ALB (P<0.05); the percentages of CD4⁺CD38⁺T and CD4⁺HLA-DR+T cells were not significantly correlated with the above indicators(P>0.05). The expression of CD38 and HLA-DR in T cells in the convalescent phase of IM were lower than those in the acute phase(P<0.05). ROC curve analysis of the percentages of CD8⁺CD38⁺T and CD8⁺HLA-DR+T cells showed that the AUC values for diagnosing IM in children were 0.931 and 0.993, respectively, the specificity was 100 %, and the sensitivity was 88.89 % and 93.33 %, respectively. Conclusion: The detection of CD38 and HLA-DR in T cells by flow cytometry is helpful for predicting the development of IM. The percentage of CD8⁺CD38⁺T and CD8⁺HLA-DR+T cells in peripheral blood cells can not only reflect the severity of liver function damage in the acute phase of IM, but also serve as a flow-diagnostic indicator for children with IM.