文章摘要
黄湘荣， 黄华， 陆普选， 曾政， 陈小芳， 周伯平， 刘映霞， 袁静， 李国保， 邓群益.人感染H7N9禽流感肺炎CT表现与病毒载量及CD4+T淋巴细胞的相关性[J].放射学实践,2014,(07):751-755
人感染H7N9禽流感肺炎CT表现与病毒载量及CD4+T淋巴细胞的相关性
The correlation of CT manifestation,viral load and CD4+T lymphocyts in patients with H7N9 avian influenza pneumonia
  
DOI：10.13609/j.cnki.1000 0313.2014.07.005
中文关键词: 禽流感  病毒载量  T淋巴细胞亚群  体层摄影术,X线计算机
基金项目:深圳市知识创新计划重点项目(JCYJ201304011 64750006)；广东省医学科研基金 (A2011543)
作者单位
黄湘荣， 黄华， 陆普选， 曾政， 陈小芳， 周伯平， 刘映霞， 袁静， 李国保， 邓群益 深圳市第三人民医院放射科 
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中文摘要:
      【摘要】目的：探讨人感染H7N9禽流感肺炎CT扫描半定量评分与病毒载量、CD4+T淋巴细胞数量的动态变化及相关性。方法：搜集2013年12月-2014年2月本院确诊的9例人感染H7N9禽流感患者的临床资料，所有患者入院后行每日病毒M片段Ct值测定、血常规及T淋巴细胞亚群检测、定期胸部CT扫描，根据CT表现进行半定量评分，观察三者的变化，并进行统计学分析。结果：病程早期（≤4d）：明确诊断2例，病毒M片段Ct值分别为34.28和30.48。3例患者病程早期共行4次胸部CT扫描和T淋巴细胞亚群检测，CT表现半定量评分平均为3.68±1.25，CD4+T淋巴细胞数平均为33.03±3.34。病程进展期（5d≤d≤10d）：病程的第5～7天病毒M片段Ct值达到低值28.72±3.88，8～10d病毒M片段Ct值增加为30.57±3.07，但两者差异无统计学意义（t=0.747，P＞0.05）。肺炎CT表现评分和CD4+T淋巴细胞变化略滞后于病毒载量变化，于8～10d CT表现评分达到峰值（12.94±6.10），与早期相比，CT评分均值增加50%，而CD4+T淋巴细胞数降低为24.39±5.15。病程恢复期（≥11d），此期病毒载量下降或转阴，CD4+T淋巴细胞数恢复正常，肺部病灶吸收减少。结论：在病变进展期，人感染H7N9禽流感病毒载量、CD4+T淋巴细胞与胸部CT表现半定量评分存在一定相关性。监测三者的变化趋势，对临床疗效评估及预后判断具有重要意义。
      【Abstact】Objective：To investigate the dynamic change and correlation of CT manifestations with semi-quantitative score,viral load and CD4+T lymphocyte in patients with H7N9 avian influenza pneumonia.Methods：The clinical and imaging materials of 9 patients having H7N9 avian influenza pneumonia in the time period of 2013-12 to 2014-02 were collected.The viral M fragment Ct values and blood routine,T lymphocyte subtype were examined every day after admission,chest CT examination was performed regularly.The changes of CT semi quantitative score,viral load and CD4+T lymphocyts were studied and analyzed statistically.Results：Two patients in early phase were diagnosed on the 3th d and 4th d respectively （≤4d），and the viral M fragment Ct value was 34.28,30.48 respectively.3 patients had totally 4 times of chest CT and T lymphocyte subtype examination.The averages of CT semi quantitative score and CD4+ T lymphocyte were 3.68±1.25,33.03%±3.34% respectively.During the progressive period （5d≤d≤10d）,the viral M fragment Ct value reaches its lowest 5~7d after onset (28.72±3.88),and increased slightly （30.57±3.07） during 8~10d,there was no statistical difference between 5~7d and 8~10d （t=0.747，P＞0.05）.The score changes of CT manifestation and CD4+ T lymphocyte lagged behind the viral M fragment Ct value slightly,the score change of CT reached its peak （12.94±6.10） on 8~10d.Compared with that of early phase,the average CT score value increased 50%,while CD4+T lymphocyte decreases to 24.39±5.15.In the recovery phase （≥11d）,the viral load decreased or turned to negative,CD4+T lymphocyts became normal,and pulmonary lesions reduced or absorbed.Conclusion：During the progressive phase of H7N9 avian influenza pneumonia in human beings,there was a certain correlation between the semi quantitative score of CT manifestations,viral load and CD4+T lymphocyte.Monitoring the change trends of the three plays an important role in the evaluation of clinical treatment efficacy and prognosis judgement.
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