背景:免疫因素是坏死性小肠结肠炎(NEC)病理生理学的重要前兆。然而,关于不同Bell分期和需要手术的NEC患者外周血淋巴细胞亚群变化的研究很少。
方法:纳入34名NEC婴儿和33名年龄匹配的对照。NEC诊断后48h内采集外周血。采用12色流式细胞术检测外周血B和T淋巴细胞亚群。计算细胞比率,评估了它们与疾病严重程度的关系以及它们作为手术指标的作用.
结果:NEC患者显示unSwB细胞(CD27+IgD+未转换记忆/活化B细胞)/B细胞的百分比升高,SwB细胞(CD27+IgD转换记忆B细胞)/B细胞,CD8+T(CD3+CD8+T细胞)/T细胞,Tem(CD45RA-CCR7效应记忆T细胞)/CD4+T细胞,Tem/CD8+T细胞和Bn(CD27-IgD+初始B细胞)/B细胞减少,CD4+T(CD3+CD4+T细胞)/T细胞,CD45RA+CCR7+初始T细胞(CD45RA+CCR7+初始T细胞)/CD8+T细胞。与BELLI+II期的NEC患者相比,BELLIII期患者的SwB细胞/B细胞百分比增加,抗体分泌细胞(ASC,CD3-CD20-CD27highCD38highASCs)/B细胞和Tem/CD4+T细胞,CD45RA+CCR7+初始T细胞/CD4+T细胞的百分比降低。受试者工作特征曲线分析表明,ASC/B细胞比例(0.52%)的敏感性为86.67%,Tem/CD4T比例(5.22%)的特异性为100%,表明NEC患者需要手术。
结论:NEC的严重程度随着B和T淋巴细胞的成熟而表现出共向变化,特别是CD4+T细胞。增加的ASC/B和Tem/CD4+T细胞可以作为需要手术的NEC患者的潜在指标。
BACKGROUND: Immune factors are important antecedents in the pathophysiology of necrotizing enterocolitis (NEC). However, studies on the peripheral blood lymphocyte subsets changes in NEC patients among different Bell stages and in patients requiring surgery are scarce.
METHODS: 34 infants with NEC and 33 age-matched controls were included. Peripheral blood was collected within 48 h after NEC diagnosis. Peripheral blood B and T lymphocytes subsets were detected by 12-color flow cytometry. Cell ratios were calculated, and their relationship to disease severity and their roles as indicators for surgery were assessed.
RESULTS: NEC patients showed elevated percentages of unSwB cells (CD27+IgD+ unswitched memory/activated B cells)/B cells, SwB cells (CD27+IgD-switched memory B cells)/B cells, CD8+ T (CD3+CD8+ T cells)/T cells, Tem (CD45RA-CCR7-effector memory T cells)/CD4+ T cells, Tem/CD8+ T cells and decreased Bn (CD27-IgD+ naïve B cells)/B cells, CD4+T (CD3+CD4+ T cells)/T cells, CD45RA+ CCR7+ naïve T cells (CD45RA+CCR7+ naïve T cells)/CD8+T cells. Compared to NEC patients at BELL stage I + II, patients at BELL stage III showed increased percentages of SwB cells/B cells, antibody secreting cell (ASC, CD3-CD20-CD27high CD38high ASCs)/B cells and Tem/CD4+ T cells, and decreased percentages of CD45RA+CCR7+ naïve T cells/CD4+ T cells. The Receiver Operating Characteristic Curve analysis showed that the sensitivity of ASC/B cells ratio (0.52%) is 86.67% and the specificity of Tem/CD4+T ratio (5.22%) is 100%, indicating that NEC patients required surgery.
CONCLUSIONS: The severity of NEC exhibits codirectional changes with the maturation of B and T lymphocytes, especially CD4+ T cells. The increased ASC/B and Tem/CD4+ T cells could serve as potential indicators for NEC patients requiring surgery.