新型冠状病毒肺炎
无症状感染者的临床与免疫学特征分析

申?川; 秦?浩; 马路园; 李星宇; 宋枚芳; 张云涛; 高会霞; 王?洋; 戴二黑; 赵彩彦

文章摘要

新型冠状病毒肺炎无症状感染者的临床与免疫学特征分析

Clinical and immunological characteristics of asymptomatic carriers of COVID-19

DOI：10.3969/j.issn.1007-8134.2022.04.004

中文关键词: 新型冠状病毒肺炎严重急性呼吸综合征冠状病毒2型无症状感染者临床特点免疫应答细胞因子趋化因子 T细胞

英文关键词: COVID-19 SARS-CoV-2 asymptomatic carrier clinical characteristc immune response cytokine chemokine T cell

基金项目:河北省重点研发计划项目（20277702D）；河北省感染性疾病临床医学研究中心创新能力提升项目（20577704D）；国家自然科学基金青年科学基金（81900536）

作者	单位
申?川	河北医科大学第三医院感染科，河北省感染性疾病临床医学研究中心，河北省重大传染病诊治与应急防控重点实验室
秦?浩	石家庄市第五医院重症医学科
马路园	河北医科大学第三医院感染科，河北省感染性疾病临床医学研究中心，河北省重大传染病诊治与应急防控重点实验室
李星宇	河北医科大学第三医院感染科，河北省感染性疾病临床医学研究中心，河北省重大传染病诊治与应急防控重点实验室
宋枚芳	河北医科大学第三医院感染科，河北省感染性疾病临床医学研究中心，河北省重大传染病诊治与应急防控重点实验室
张云涛	唐山市传染病医院肝病科
高会霞	石家庄市第五医院重症医学科
王?洋	石家庄市第五医院重症医学科
戴二黑	石家庄市第五医院重症医学科
赵彩彦	河北医科大学第三医院感染科，河北省感染性疾病临床医学研究中心，河北省重大传染病诊治与应急防控重点实验室

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中文摘要:

[摘要]　目的　探讨新型冠状病毒肺炎（coronavirus disease 2019, COVID-19）无症状感染者的临床和免疫学特征。方法　选取2020年1月22日—6月22日石家庄市第五医院收治的59例COVID-19患者作为研究对象，分析不同疾病分期患者的临床资料。利用流式细胞术检测患者外周血T淋巴细胞亚群计数，Procarta Plex多细胞因子检测系统检测外周血25种细胞因子和9种趋化因子水平。结果　59例COVID-19患者中，无症状感染组28例（47.5%）、轻型组6例（10.2%）、普通型组19例（32.2%），重型/危重型组6例（10.2%）。无症状感染组中位年龄为23.0（19.3，34.8）岁，显著低于普通型组的35.0（24.0，52.0）岁和重型/危重型组的64.5（52.0，68.3）岁（P均＜0.05）。无症状感染组患者较少患有基础疾病，均无症状、体征和胸部CT变化，其外周血CD3+ T细胞、CD4+ T细胞、CD8+ T细胞计数均显著高于重型/危重型组（P均＜0.05），同时CD4+ T细胞计数显著高于普通型组（P＜0.05）。14例无症状感染组患者治疗前与治疗后CD3+ T细胞、CD4+ T细胞和CD8+ T细胞计数比较，差异均无统计学意义（P均＞0.05）。14例无症状感染组患者治疗前后CD4+ T细胞计数的变化幅度均显著低于普通型组、重型/危重型组（P均＜0.05）。无症状感染组外周血可检测到11种细胞因子和趋化因子，其中IL-7水平显著高于对照组， IP-10水平均显著低于普通型组、重型/危重型组，差异均具有统计学意义（P均＜0.05）。结论　COVID-19无症状感染者以青年为主，但未发现与性别因素相关。随着COVID-19病情进展，普通型、重型/危重型患者外周血T细胞亚群计数降低，而细胞因子和趋化因子水平升高，但上述指标在无症状感染者中未见显著改变。

英文摘要:

[Abstract]　Objective　To explore clinical and immunological characteristics of asymptomatic carriers of COVID-19. Methods?Fifty nine cases with COVID-19 were admitted to the Shijiazhuang Fifth Hospital during January 22, and June 22, 2020, and the clinical data of patients were analyzed. The T lymphocyte subsets counts were analyzed by flow cytometry. Twenty-five serum cytokines and 9 chemokines release level in peripheral blood were detected by Procarta Plex. Result?Of the 59 patients with COVID-19, there were 28 asymptomatic carriers (47.5%), 6 mild cases (10.2%), 19 moderate cases (32.2%), and 6 severe/critical cases (10.2%). The median age of asymptomatic carriers was 23.0 (19.3, 34.8), which was significantly lower than moderate cases with 35.0 (24.0, 52.0) and severe/critical cases with 64.5 (52.0, 68.3) (P＜0.05). Asymptomatic carriers had fewer underlying diseases, clinical symptoms, signs and thoracic abnormalities on computed tomography. The CD3+ T cell, CD4+ T cell and CD8+ T cell counts in peripheral blood were significantly higher in asymptomatic carriers than those in severe/critical cases (P＜0.05). The CD4+ T cell counts were significantly higher in asymptomatic carriers than those of moderate cases (P＜0.05). The CD3+ T cell, CD4+ T cell and CD8+ T cell counts before and after treatment displayed no significant changes in 14 asymptomatic carriers (P＜0.05). The changes of CD4+ T cell counts before and after treatment in 14 asymptomatic carriers were significantly lower than those in moderate and severe/critical cases (P＜0.05). Eleven cytokines and chemokines were detectable in serum of asymptomatic carriers. The level of IL-7 was significantly higher than that of control group, and the IP-10 was significantly lower compared with moderate and severe/critical cases (P＜0.05). Conclusions?The majority of COVID-19 asymptomatic carriers were young people, but there was no correlation with gender factors. With the progression of COVID-19, the counts of T cell subsets in periphery decreased in moderate and severe/critical patients, while the levels of cytokines and chemokines increased. However, no significant changes were observed in asymptomatic carriers.

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