感染性肺炎与免疫相关间质性肺病中淋巴细胞亚群的表达

doi:10.19723/j.issn.1671-167X.2026.03.024

摘要/Abstract

摘要：

目的: 比较感染性肺炎和免疫相关间质性肺病(immune-related interstitial lung disease, IRILD)患者淋巴细胞亚群表达的差异，评估不同肺炎患者的免疫状态，从免疫学的角度为有效鉴别不同肺炎提供新的实验室指标。方法: 连续纳入2023年1月至2024年3月就诊于北京大学人民医院风湿免疫科的感染性肺炎患者27例、单纯IRILD患者27例以及IRILD合并感染患者24例，并选择同期进行体检的50名健康志愿者作为对照组。采用流式细胞术检测各组淋巴细胞亚群水平。结果: 病例组与对照组间年龄差异无统计学意义(P>0.05)。在实验室指标方面，与IRILD组相比，感染性肺炎组患者中性粒细胞、C反应蛋白、降钙素原(procalcitonin，PCT)、红细胞沉降率(erythrocyte sedimentation rate，ESR)、D-二聚体、纤维蛋白原水平增高(P＜0.05)，IRILD合并感染组患者PCT、ESR、免疫球蛋白G水平增高(P＜0.05)。在淋巴细胞亚群水平方面，与对照组相比，感染性肺炎组患者的T、B、自然杀伤(natural killer，NK)、CD4⁺T细胞数，CD4⁺/CD8⁺比值明显降低(P＜0.05)，IRILD组患者的T、B，CD4⁺T细胞数、CD4⁺/CD8⁺比值明显降低(P＜0.05)，IRILD合并感染组患者T、B、NK、CD4⁺T、CD8⁺T细胞数明显降低(P＜0.05)。与IRILD组患者相比，感染性肺炎组患者NK细胞数明显下降(P＜0.05)，IRILD合并感染组患者NK、CD8⁺T细胞数明显降低(P＜0.05)。结论: 不同肺炎淋巴细胞亚群水平存在一定差异，为有效鉴别不同肺炎提供了新的思路。

关键词: 感染性肺炎, 免疫相关间质性肺病, 淋巴细胞亚群

Abstract:

Objective: To delineate differences in lymphocyte subset expression between patients with infectious pneumonia and immune-related interstitial lung disease (IRILD), to assess the immune status across distinct pneumonia types, and to provide novel laboratory markers through immunological profiling to effectively differentiate pneumonias. Methods: A total of 78 patients sequentially enrolled from Peking University People' s Hospital between January 2023 and March 2024 were stratified into three groups: 27 with infectious pneumonia, 27 with isolated immune-related interstitial lung disease (IRILD), and 24 with IRILD complicated by infection. Fifty age-matched healthy individuals undergoing routine physical examinations during the same period served as controls. Peripheral lymphocyte subsets were quantified in all subjects by multiparametric flow cytometry. Results: There was no statistically significant difference in age between the pneumonia patients and the healthy control group in this study (P>0.05). Analysis of laboratory parameters revealed that compared with the IRILD group, the infectious pneumonia group demonstrated significantly elevated levels of neutrophils, C-reactive protein, procalcitonin (PCT), erythrocyte sedimentation rate (ESR), D-dimer, and fibrinogen (P < 0.05), while the IRILD with superimposed infection group exhibited significantly increased levels of PCT, ESR, and immunoglobulin G (P < 0.05). At the lymphocyte subset level, compared with the control group, the infectious pneumonia group exhibited significantly decreased counts of T cells, B cells, natural killer (NK) cells, CD4⁺T cells, and the CD4⁺/CD8⁺ ratio (P < 0.05). Similarly, compared with the control group, the IRILD group showed significantly reduced counts of T cells, B cells, CD4⁺T cells, and the CD4⁺/CD8⁺ ratio (P < 0.05). Furthermore, compared with the control group, the IRILD-with-infection group demonstrated significantly lower counts of T cells, B cells, NK cells, CD4⁺T cells, and CD8⁺T cells (P < 0.05). Compared with the IRILD group, the infectious pneumonia group had a significantly lower NK cell count (P < 0.05). Additionally, compared with the IRILD group, the IRILD-with-infection group displayed significantly reduced counts of NK cells and CD8⁺T cells (P < 0.05). Conclusion: The study revealed significant variations in lymphocyte subset profiles among the distinct pneumonia groups, providing novel insights with potential diagnostic value for differentiating between pneumonia types.

Key words: Infectious pneumonia, Immune-related interstitial lung disease, Lymphocyte subpopulations

中图分类号:

R563

赵豆豆, 齐晅, 黄博, 高伟波, 裴源源, 金月波, 邵苗, 何菁. 感染性肺炎与免疫相关间质性肺病中淋巴细胞亚群的表达[J]. 北京大学学报（医学版）, 2026, 58(3): 624-630.

Doudou ZHAO, Xuan QI, Bo HUANG, Weibo GAO, Yuanyuan PEI, Yuebo JIN, Miao SHAO, Jing HE. Expression and clinical significance of lymphocyte subsets in infectious pneumonia and immune-related interstitial lung disease[J]. Journal of Peking University (Health Sciences), 2026, 58(3): 624-630.

图/表 3

表1

表2

患者组间临床特征比较"

Characteristics	Infectious pneumonia group(n=27)	IRILD group(n=27)	IRILD with infection group(n=24)	F/x²/H	P value
Common symptoms
Fever	24 (88.9)	2 (7.4)^a	13 (54.2)^a，b	χ²=36.09	P＜0.001
Cough	18 (66.7)	8 (29.6)^a，c	19 (79.2)	χ²=14.14	P＜0.001
Dyspnea	5 (18.5)	3 (11.1)	7 (29.2)	χ²=2.59	0.321^#
Co-existing complications
Other	11 (40.7)	17 (63.0)	14 (58.3)	χ²=2.96	0.222
Hypertension	14 (51.9)	8 (29.6)	6 (25.0)	χ²=4.69	0.101
Diabetes	11 (40.7)	6 (22.2)	4 (16.7)	χ²=4.96	0.20^#
CVD	2 (7.4)	2 (7.4)	4 (16.7)	χ²=1.45	0.577^#
Biochemical indexes
WBC/(×10⁹/L)	8.73 (5.61, 10.75)	7.80 (6.39, 8.30)	7.09 (5.15, 9.63)	H=3.59	0.166
LYM/(×10⁹/L)	1.32±0.77	1.73±0.91	1.28±0.64	F=2.61	0.080
NEU/(×10⁹/L)	6.72 (4.42, 8.30)^b	4.85 (3.80, 5.58)	5.17 (3.68, 7.27)	H=6.57	0.038
HB/(g/L)	110.40±21.78	129.89±16.90^a	122.25±16.24^a	F=7.55	0.001
PLT/(×10⁹/L)	234.48±127.90	230.89±76.54	262.38±101.67	F=0.68	0.509
ALT/(U/L)	22.00 (12.00, 36.00)	18.00 (13.00, 27.00)	15.00 (11.25, 49.75)	H=0.38	0.828
AST/(U/L)	21.00 (15.00, 28.00)	21.00 (16.00, 24.00)	26.00 (18.00, 37.75)	H=2.13	0.346
Scr/(μmol/L)	77.00 (60.00, 138.96)	65.00 (55.00, 79.00)	72.00 (56.25, 83.00)	H=3.46	0.177
CRP/(mg/L)	55.40 (14.20, 91.80)	1.10 (0.50, 3.90)^a	5.90 (1.30, 24.70)^a	H=28.95	P＜0.001
PCT/(μg/L)	0.15 (0.10, 0.61)^b	0.04 (0.03, 0.07)	0.20 (0.06, 0.52)^b	H=21.42	P＜0.001
ESR/(mm/h)	47.32 (39.00, 53.00)^b	13.00 (7.00, 18.00)	33.50 (11.00, 70.00)^b	H=28.95	P＜0.001
D-dimer/(μg/L)	477.00 (203.00, 1 146.00)^b	112.00 (75.00, 322.80)	254.00 (92.75, 496.25)	H=14.67	P＜0.001
FIB/(mg/dL)	417.50±105.09	330.58±54.89^a	377.33±115.00	F=5.72	0.005
IgG/(g/L)	9.40±3.66^c	11.49±3.66^c	15.81±4.47	F=17.37	P＜0.001
IgA/(g/L)	2.00 (1.48, 2.26)	2.37 (1.63, 2.79)	2.65 (1.94, 3.36)	H=5.79	0.055
IgM/(g/L)	0.91 (0.43, 1.07)	1.05 (0.67, 1.52)	1.14 (0.77, 2.07)	H=5.34	0.069
C3/(g/L)	1.29±0.29^c	1.34±0.18^c	1.14±0.29	F=3.73	0.028
C4/(g/L)	0.38 (0.36, 0.41)^c	0.34 (0.27, 0.41)	0.26 (1.94, 3.36)	H=11.18	0.004
Initial treatment
GC therapy	0 (0)	23 (85.2)^a	21 (87.5)^a	χ²=61.00	P＜0.001^#
csDMARDs	0 (0)	23 (85.2)^a	22 (91.7)^a	χ²=64.43	P＜0.001^#
tDMARDs	0 (0)	1 (3.7)	5 (20.8)^a	χ²=7.02	0.012^#

表2

图1

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Items	Control (n=50)	Infectious pneumonia (n=27)	IRILD (n=27)	IRILD with infection (n=24)	F/χ²	P
Male	17 (34.0)	19 (70.4)	8 (29.6)	9 (37.5)	χ²=11.82	P＜0.05
Age/years	55.3±9.4	60.3±16.9	60.5±13.9	60.0±12.8	F=1.50	P＞0.05
Infection type					χ²=2.06	P＞0.05
Virus		10 (37.0)		6 (25.0)
Bacteria		14 (51.9)		17 (70.8)
Bacteria + virus		2 (7.4)
Fungus		1 (3.7)		1 (4.2)
IRILD etiology					χ²=5.56	P＞0.05
IIM			12 (44.4)	12 (50.0)
RA			2 (7.4)	3 (12.5)
SS			2 (7.4)	3 (12.5)
SSc				2 (8.3)
AAV				1 (4.2)
IPAF			11 (40.8)	3 (12.5)

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