Korean Journal of Nephrology 1992;11(4):326-340.

한국형출혈열에서의 말초 혈액 임파구 아형의 변화

이종호 , 김근호 , 김윤구 , 강응택 , 한진석 , 김성권 , 이정상

Abstract

Korean hemorrhagic fever (KHF) is an acute febrile illness caused by Hantaan virus, the prototype of Hantavirus. The etiologic agent, pathologic characteris- tics and clinical feature of KHF is well established, but pathophysiologic mechanism remains unsettled. On the basis of findings such as long incubation period of KHF, progress of disease in spite of early rise of serum anti- body titer with clearance of viremia, activation of com- plement system, and formation of circulating immune complex it was suggested that immunologic mechanism may be involved in the pathogensis of KHF. Moreover, certain facts such as lymphadenopathy, peripheral lymphocytosis and infiltration of mononuclear cells in various organs, led us to the hypothesis that cell mediat- ed immune response is important in the pathogenesis of KHF. To evaluate the cell mediated immune response in KHF, daily changes of peripheral blood lymphocyte subsets and expression of activation antigens such as HLA-DR and interleukin-2 receptor (CD25) antigen in 27 KHF patients were examined by flow cytometry method. The results were compared with 29 normal controls (NC). 1) Total white blood cell count increased significant! Y from the 5th to the 10th day of illness with maximum number (23,088+3,521/mm) observed on the 6th day (NC; 6,159±241/mm). Differential count showed signifi- cantly increased lymphocyte (5,315±744/mm) espe- cially atypical lymphocyte number (4,208±658/mm) on the 6th day of illness. 2) Among the lymphocytes, number of CD3+cell in- creased from the 5th to the 7th day of illness and normalized thereafter. Maximum number of CD3+cell (4,014±649/mm) was observed on the 6th day (NC; 1, 288±56/mm'). Number of CD19+cell showed no signifi- cant difference from NC (116±10 mm). 3) Among T lymphocytes, number of CD4+cell did not show significant change from NC (704 X32/mm), but number of CD8+cell increased significantly on the 6th E z 7th day of illness (maximum; 3,474±641/mm on (107±45/mm) compared with NC (92.4±0.6/mm). Normalized. CD4/CDS ratio decreased maximally on the 7th of illness (0.27±0.04) and increased thereafter (NC; 1.54 ± 0.10). 4) Expression rate of HLA-DR antigen was signifi- cantly increased from the 5th to the 9th day of illness. Number of cells expressing interleukin-2 receptor antigen was also increased on the 6th day of illness (107±45/mm') compared with NC 92.4±0.6/mm). In conclusion, from the 5th to the 8th day of illness significant elevation of number of CD8+ cell and atypical lymphocyte along with significant depression of CD4/CDS ratio was observed in KHF patients. Above phenomenon seems to reflect activation of the cell mediated immune system. (values are mean+standard error.)