中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2012年
9期
588-592
,共5页
丁艳%尹薇%熊越华%彭芳%刘莉
丁豔%尹薇%熊越華%彭芳%劉莉
정염%윤미%웅월화%팽방%류리
黏膜皮肤淋巴结综合征%T淋巴细胞亚群%B淋巴细胞
黏膜皮膚淋巴結綜閤徵%T淋巴細胞亞群%B淋巴細胞
점막피부림파결종합정%T림파세포아군%B림파세포
Mucocutaneous lymph node syndrome%T-lymphocyte subsets%B-lymphocytes
目的 总结川崎病(KD)的细胞免疫及体液免疫特征,探讨细胞免疫及体液免疫功能在川崎病发病机制中的作用及临床检测价值.方法 速率散射比浊法检测196例川崎病患儿的免疫球蛋白IgG、IgM、IgA、补体C3、C4水平,流式细胞仪免疫荧光法检测T细胞亚群、自然杀伤细胞、B细胞变化.统计学方法采用x2检验、2个独立样本的t检验及Spearman等级相关分析.结果 196例川崎病患儿中,典型川崎病172例,不完全性川崎病24例,静脉注射免疫球蛋白(IVIG)无反应型17例,IVIG敏感型179例,合并冠状动脉病变(CAL) 34例；IVIG无反应型川崎病的CAL发生率(52.9％)显著高于IVIG敏感型(14.0％)(x2=16.45,P＜0.05).与健康对照组相比,急性期川崎病组CD19细胞绝对值(1165±556)/μl、CD4/CD8比值(2.19±0.77)、IgM (1.41 ±0.45) g/L、IgA (0.81 ±0.35) g/L、补体C3 (1.31 ±0.26) g/L显著升高(P均＜0.05),CD8细胞(671 ±308 )/μl、自然杀伤细胞(337±233)/μl绝对值显著降低(P均＜0.05)；川崎病患儿中,IVIG无反应型的CD19细胞绝对值、CD4/CD8比值、IgM、补体C3水平分别高于IVIG敏感型(P均＜0.05),CD8、自然杀伤细胞绝对值则低于后者(P均＜0.05),合并CAL者的CD19细胞绝对值、CD4/CD8比值、IgM、IgA水平高于无CAL者(P均＜0.05),CD8、自然杀伤细胞绝对值低于后者(P均＜0.05)；典型川崎病与不完全性川崎病相比,上述各项指标的差异无统计学意义(P均＞0.05)；CAL严重程度分级与急性期CD4/CD8 (Th/Ts)比值呈正相关(P＜0.05).结论 川崎病急性期存在细胞及体液免疫功能的紊乱,均参与了川崎病的发病机制,细胞免疫功能紊乱更为显著；其中IVIG无反应型及合并CAL的川崎病免疫紊乱更显著；IVIG无反应型有更高的CAL发生率；CD4/CD8比值与川崎病血管损伤的严重程度有关.
目的 總結川崎病(KD)的細胞免疫及體液免疫特徵,探討細胞免疫及體液免疫功能在川崎病髮病機製中的作用及臨床檢測價值.方法 速率散射比濁法檢測196例川崎病患兒的免疫毬蛋白IgG、IgM、IgA、補體C3、C4水平,流式細胞儀免疫熒光法檢測T細胞亞群、自然殺傷細胞、B細胞變化.統計學方法採用x2檢驗、2箇獨立樣本的t檢驗及Spearman等級相關分析.結果 196例川崎病患兒中,典型川崎病172例,不完全性川崎病24例,靜脈註射免疫毬蛋白(IVIG)無反應型17例,IVIG敏感型179例,閤併冠狀動脈病變(CAL) 34例；IVIG無反應型川崎病的CAL髮生率(52.9％)顯著高于IVIG敏感型(14.0％)(x2=16.45,P＜0.05).與健康對照組相比,急性期川崎病組CD19細胞絕對值(1165±556)/μl、CD4/CD8比值(2.19±0.77)、IgM (1.41 ±0.45) g/L、IgA (0.81 ±0.35) g/L、補體C3 (1.31 ±0.26) g/L顯著升高(P均＜0.05),CD8細胞(671 ±308 )/μl、自然殺傷細胞(337±233)/μl絕對值顯著降低(P均＜0.05)；川崎病患兒中,IVIG無反應型的CD19細胞絕對值、CD4/CD8比值、IgM、補體C3水平分彆高于IVIG敏感型(P均＜0.05),CD8、自然殺傷細胞絕對值則低于後者(P均＜0.05),閤併CAL者的CD19細胞絕對值、CD4/CD8比值、IgM、IgA水平高于無CAL者(P均＜0.05),CD8、自然殺傷細胞絕對值低于後者(P均＜0.05)；典型川崎病與不完全性川崎病相比,上述各項指標的差異無統計學意義(P均＞0.05)；CAL嚴重程度分級與急性期CD4/CD8 (Th/Ts)比值呈正相關(P＜0.05).結論 川崎病急性期存在細胞及體液免疫功能的紊亂,均參與瞭川崎病的髮病機製,細胞免疫功能紊亂更為顯著；其中IVIG無反應型及閤併CAL的川崎病免疫紊亂更顯著；IVIG無反應型有更高的CAL髮生率；CD4/CD8比值與川崎病血管損傷的嚴重程度有關.
목적 총결천기병(KD)적세포면역급체액면역특정,탐토세포면역급체액면역공능재천기병발병궤제중적작용급림상검측개치.방법 속솔산사비탁법검측196례천기병환인적면역구단백IgG、IgM、IgA、보체C3、C4수평,류식세포의면역형광법검측T세포아군、자연살상세포、B세포변화.통계학방법채용x2검험、2개독립양본적t검험급Spearman등급상관분석.결과 196례천기병환인중,전형천기병172례,불완전성천기병24례,정맥주사면역구단백(IVIG)무반응형17례,IVIG민감형179례,합병관상동맥병변(CAL) 34례；IVIG무반응형천기병적CAL발생솔(52.9％)현저고우IVIG민감형(14.0％)(x2=16.45,P＜0.05).여건강대조조상비,급성기천기병조CD19세포절대치(1165±556)/μl、CD4/CD8비치(2.19±0.77)、IgM (1.41 ±0.45) g/L、IgA (0.81 ±0.35) g/L、보체C3 (1.31 ±0.26) g/L현저승고(P균＜0.05),CD8세포(671 ±308 )/μl、자연살상세포(337±233)/μl절대치현저강저(P균＜0.05)；천기병환인중,IVIG무반응형적CD19세포절대치、CD4/CD8비치、IgM、보체C3수평분별고우IVIG민감형(P균＜0.05),CD8、자연살상세포절대치칙저우후자(P균＜0.05),합병CAL자적CD19세포절대치、CD4/CD8비치、IgM、IgA수평고우무CAL자(P균＜0.05),CD8、자연살상세포절대치저우후자(P균＜0.05)；전형천기병여불완전성천기병상비,상술각항지표적차이무통계학의의(P균＞0.05)；CAL엄중정도분급여급성기CD4/CD8 (Th/Ts)비치정정상관(P＜0.05).결론 천기병급성기존재세포급체액면역공능적문란,균삼여료천기병적발병궤제,세포면역공능문란경위현저；기중IVIG무반응형급합병CAL적천기병면역문란경현저；IVIG무반응형유경고적CAL발생솔；CD4/CD8비치여천기병혈관손상적엄중정도유관.
Objective The purpose of the study was to summarize the characteristics of cellular and humoral immunity in children with Kawasaki's disease (KD),and to explore the role of cellular and humoral immunity in the pathogenesis of KD.Methods One hundred and ninety-six subjects with KD were diagnosed and observed.The serum IgG,IgM,IgA and C3,C4 levels were detected by velocity scatter turbidimetry.The levels of T lymphocyte subsets,natural killer cells (NK cells),and B cells were analyzed by flow cytometry.Chi-square test,independent t-test and Spearman analysis were adopted to analyze data.Results One hundred and seventy-two cases were diagnosed as typical KD,24 cases were incomplete KD,17 cases were refractory KD,179 cases responded to IVIG therapy,and 34 cases were CAL.The occurrence of coronary artery lesion (CAL) in the refractory KD group was 52.9％,which was evidently higher than those patients responding to IVIG therapy (14.0％,P＜0.05).In the group of KD,the level of CD19 absolute value (1165±556)/μl was higher than that in the control group(P＜0.05),the ratio of CD4/CD8 (2.19±0.77) was higher than that in the control group (P＜0.05),the levels of serum IgM ( 1.41 ±0.45) g/L,IgA (0.81 ±0.35) g/L,C3 ( 1.31 ±0.26) g/L were higher than those in the control group (P＜0.05),the levels of CD8 (671±308)/μl,NK (337±233)/μl absolute value were lower than those in thc control group (P＜0.05).In refractory KD subgroup,the levels of CD19 absolute value,serum IgM,C3 and the ratio of CD4/CD8 were higher than those in the subgroup responding to IVIG therapy(P＜0.05),while the levels of CD8,NK absolute value were lower than those in the latter (P＜0.05).In the CAL subgroup,the levels of CD19 absolute value,serum IgM,IgA and the ratio of CD4/CD8 were higher than those in the non-CAL subgroup (P＜0.05),while the levels of CD8,NK absolute value were lower than those in the latter (P＜0.05).The differences of all data between typical KD subgroup and incomplete KD subgroup were insignificant (P＞0.05).The severity grade of CAL was positively correlated with the ratio of CD4/CD8 (P＜0.05).Conclusion There are cellular immunity and humoral immunity disturbances in the acute stage of KD,while cellular immunity disturbances are more striking.Cellular immunity and humoral immunity are all involved in the pathogenesis of KD.The immunity dysfunction is more significant in refractory KD and CAL.The occurrence rate of CAL is high in refractory KD.The ratio of CD4/CD8 is relevant to the severity of vascular injury.
