中文摘要：

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。

英文摘要：

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（P0.01）. The mean and median of LTR of IBD patients who did not receive BA or surgical treatment were significantly 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.