CAJ | 학술논문

目的探讨肠道病毒71型(EV71)感染患儿免疫功能变化与病情程度的关系.方法患儿46例,健康同龄儿童12例,根据病情由轻到重将患儿分为4组:手足口病组11例、中枢神经系统病变组20例、中枢神经系统病变伴自主神经功能失调组10例、神经源性肺水肿组(pulmonaryedema,PE组)5例.进行下述检测:CD14~+单核细胞人类白细胞DR抗原(HLA-DR)表达率、淋巴细胞免疫分型、CD4~+CD25~+Foxp3~(high)调节性T细胞(regulatory T cells,Treg cells)及TH17细胞比例;白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)、白细胞介素10(IL-10)、转录生长因子β(TGF-β)、白细胞介素6(IL-6)、白细胞介素17A(IL-17A)血浓度;CD~4T细胞Foxp3、ROR-γt基因表达;血清免疫球蛋白及补体等.结果 (1)前炎症细胞因子TNF-α及IL-1β在轻症患儿中增高,随病情加重而下降,PE组明显降低(P<0.05);抗炎细胞因子IL-10及IL-10/TNF-α比值随病情加重增高,PE组增高明显(P<0.05).(2)HLA-DR、CD3~+T细胞、CD4~+T细胞、CD8~+T细胞、NK细胞随病情加重呈现逐步下降趋势,PE组下降最为明显(P<0.05).各组间B淋巴细胞及抗体差异无统计学意义.(3)Treg细胞比例、转录因子Foxp3 mRNA及诱导因子TGF-β血浓度随病情加重降低,而TH17细胞比例、IL-17A血浓度、转录因子ROR-γt mRNA及诱导因子IL-6血浓度随病情加重升高.结论 EV71感染患儿机体免疫功能随病情程度而变化,轻症患儿处于全身炎症反应状态,重症或危重症病例处于代偿性抗炎症反应或混合性拮抗反应状态,对EV71感染的免疫调控治疗应强调分阶段、个体化.
목적 탐토장도병독71형(EV71)감염환인면역공능변화여병정정도적관계.방법 환인46례,건강동령인동12례,근거병정유경도중장환인분위4조:수족구병조11례、중추신경계통병변조20례、중추신경계통병변반자주신경공능실조조10례、신경원성폐수종조(pulmonaryedema,PE조)5례.진행하술검측:CD14~+단핵세포인류백세포DR항원(HLA-DR)표체솔、림파세포면역분형、CD4~+CD25~+Foxp3~(high)조절성T세포(regulatory T cells,Treg cells)급TH17세포비례;백세포개소1β(IL-1β)、종류배사인자α(TNF-α)、백세포개소10(IL-10)、전록생장인자β(TGF-β)、백세포개소6(IL-6)、백세포개소17A(IL-17A)혈농도;CD~4T세포Foxp3、ROR-γt기인표체;혈청면역구단백급보체등.결과 (1)전염증세포인자TNF-α급IL-1β재경증환인중증고,수병정가중이하강,PE조명현강저(P<0.05);항염세포인자IL-10급IL-10/TNF-α비치수병정가중증고,PE조증고명현(P<0.05).(2)HLA-DR、CD3~+T세포、CD4~+T세포、CD8~+T세포、NK세포수병정가중정현축보하강추세,PE조하강최위명현(P<0.05).각조간B림파세포급항체차이무통계학의의.(3)Treg세포비례、전록인자Foxp3 mRNA급유도인자TGF-β혈농도수병정가중강저,이TH17세포비례、IL-17A혈농도、전록인자ROR-γt mRNA급유도인자IL-6혈농도수병정가중승고.결론 EV71감염환인궤체면역공능수병정정도이변화,경증환인처우전신염증반응상태,중증혹위중증병례처우대상성항염증반응혹혼합성길항반응상태,대EV71감염적면역조공치료응강조분계단、개체화.
Objective To investigate the association of changes in immune function with enterovirus 71 (EV71) cases with different severity of the disease. Method Forty-six EV71-infected patients and 12 age-matched healthy children were enrolled in this study. The patients were divided into four groups according to critical degree of enteruvirus 71 infection: hand-foot-and-mouth disease (HFMD); central nervous system disease (CNSD); autonomic nervous system dysregulation (ANSD) and pulmonary edema (PE). We analyzed CD14~+ monocyte HLA-DR expression, lymphocyte immunophenotypes, the proportion of CD4~+ CD25~+ Foxp3~(high) regulatory T cells (Treg cells) and Th17 cells, cytokines (IL-1β, TNF-α, IL-10, TGF-β, IL-6, IL-17A), evaluated the mRNA levels of Foxp3 and ROR-γ, and serum immunoglobulin and complements. Result (1) Serum concentrations of IL-1β and TNF-α elevated in mild cases, while declined in severe cases, and were lower in PE group (P < 0.05). Serum concentrations of IL-10 and IL-10/TNF-α ratio gradually raised with the aggravation of the disease, and higher in PE group (P < 0.05). (2) Circulating CD14~+ monocyte HLA-DR expression, CD3~+ T cells, CD4~+ T cells, CD8~+ T cells, and NK cells gradually decreased, and lower in PE group (P < 0.05). There was no significant difference in B cells, immunoglobulin and complement among the four groups. (3) The proportion of CD4~+ CD25~+ Foxp3~(high) Treg cells, mRNA level of Foxp, and serum concentrations of TGF-β gradually decreased with the aggravation of the disease, while the proportion of Th17 cells, serum concentrations of IL-17A, mRNA level of ROR-γ, and IL-6 gradually increased with the aggravation. Conclusion Immune function changed with different illness phases. The mild cases presented systemic inflammatory response syndrome status, while critically ill cases presented compensatory anti-inflammatory response syndrome or mixed antagonist response status. Immunoregulatory treatment of patients with EV71 infection should emphasize different methods at different stage and individualization.