南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (12): 1609-.

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CD8+CD28+/CD8+CD28- T细胞平衡预测炎症性肠病患者并发消化道出血的价值

戴世学，顾红祥，武钢，钟涛，菅洪健，湛永乐，张旻海，高勇，徐俊，陈东升，廖广捷，封艳玲，刘洪波， 邹颖，迟宏罡   

  • 出版日期:2016-12-20 发布日期:2016-12-20

Immunological balance of CD8+CD28+/CD8+CD28- T lymphocytes can predict gastrointestinal hemorrhage in patients with inflammatory bowel disease

  • Online:2016-12-20 Published:2016-12-20

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摘要： 目的评价CD8+CD28+/CD8+CD28- T细胞平衡在预测炎症性肠病（IBD）患者并发消化道出血（GH）的作用与价值。方法 收集IBD患者49例，其中溃疡性结肠炎（UC）30例，克罗恩病（CD）19例，使用流式细胞术检测外周血CD8+CD28+及CD8+CD28- T 细胞T细胞的百分含量，对患者进行为期1年的随访，使用受试者工作特征（ROC）曲线法评价CD8+CD28+/CD8+CD28- T细胞平 衡（比值）在预测IBD患者出现GH的效能，并使用Kaplan-Meier生存分析法比较不同因素下的持续缓解时间（LTR）差异，并对 相关指标进行相关性分析。结果（1）CD组的免疫抑制剂、激素及生物制剂（BA）使用率均显著高于UC组（P=0.003、0.043及 0.002）；（2）UC组患者的CD8+CD28+ T细胞显著高于CD组（t=3.022，P=0.004）；（3）ROC结果显示CD8+CD28+ T细胞、CD8+ CD28- T 细胞及CD8+CD28+/CD8+CD28-比值三者在预测GH方面均具有良好的效能（均为P<0.01），但以CD8+CD28+/CD8+ CD28-最优［曲线下面积（AUC）为0.977，P=0.000］，截值分析显示当CD8+CD28+/CD8+CD28-比值取值为1.14 时（13.95%/ 12.24%），其对应的敏感度达93.3%，特异度为91.2%；（4）未使用BA及未行手术治疗的IBD患者算术及中位LTR均显著长于使 用BA及已行手术的IBD患者（分别为χ2=9.730，P=0.002；χ2=15.981，P=0.000）；（5）Spearman分析显示CD8+CD28+/CD8+CD28- 与BA及手术均成显著相关性（P=0.009、0.038）。结论外周血CD8+CD28+ T细胞降低或CD8+CD28- T细胞升高与IBD患者出 现GH密切相关，CD8+CD28+/CD8+CD28-平衡预测GH的敏感度及特异度均高，尤其是在比值为1.14时；该平衡与生物制剂及手 术存在显著相关性。

Abstract: Objective To evaluate the sensitivity and specificity of CD8+CD28+/CD8+CD28- T lymphocyte balance in predicting the gastrointestinal hemorrhage (GH) in patients with inflammatory bowel disease (IBD). Methods Forty-nine IBD patients, including 30 with ulcerous colitis (UC) and 19 with Crohn’s disease (CD), were enrolled to test peripheral blood CD8+CD28+ and CD8 + CD28- T cells using flow cytometry. All the patients were followed up for one year. The receiver-operating characteristic (ROC) curves were used to test the efficiency of CD8+CD28+/CD8+CD28-T lymphocyte balance to predict GH. The differences in lasting time of remission (LTR) under different factors were compared using Kaplan-Meier survival analysis, and the correlation between CD8 + T lymphocytes and the factors were analyzed. Results The utilization rates of immunosuppressant, steroids, and biological agent (BA) were significantly higher in CD patients than in UC patients (P=0.003, 0.043 and 0.002, respectively). The frequencies of CD8+CD28+T cells were obviously higher in UC patients than those in CD patients (t=3.022, P=0.004). CD8+CD28+T cells, CD8+CD28- T cells, and especially CD8+CD28+/CD8+CD28- ratio (area under curve of 0.977, P=0.000; cut-off value of 1.14［13.95%/12.24%］with a sensitivity of 93.3% and a specificity of 91.2%) showed good efficiencies in predicting GH (P<0.01). The mean and median of LTR of IBD patients who did not receive BA or surgical treatment weresignificantly longer (χ2=9.730, P=0.002; χ2=15.981, P=0.000). CD8+CD28+/CD8+CD28- ratio was significantly related to both BA (P=0.009) and surgery (P=0.038). Conclusion Both decreased CD8 + CD28 + T cells and elevated CD8 + CD28-T cells are closely correlated with GH, and their ratio can predict the occurrence of GH with a high sensitivity and specificity and is correlated with BA and surgery at the cut-off value of 1.14.