CAJ | 학술논문

目的探讨手足口病(HFMD)患儿的肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-10及免疫功能的变化。方法选择2012年5月至10月于山东省即墨市人民医院儿科手足口病门诊就诊及住院治疗的首次确诊为 H FMD患儿56例为研究对象,并将其纳入实验组。随机选择同期于本院行健康体检的20例健康儿童纳入对照组。两组儿童的性别、年龄等一般临床资料比较,差异无统计学意义(P>0.05)。检测两组儿童免疫球蛋白(Ig)A、IgG、IgM,T 淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)及血清TNF-α、IL-6、IL-10水平(本研究遵循的程序符合山东省即墨市人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书)。结果实验组与对照组 IgA、CD4+、IL-6、IL-10水平比较[(1.06±0.61)g/L vs (1.50±0.54)g/L,(30.79±8.87)%vs (35.15±5.18)%,(14.71±16.29)pg/mL vs (3.76±1.03)pg/mL,(15.38±8.77) pg/mL vs (11.39±4.99)pg/mL],差异均有统计学意义(t=2.849,2.070,2.991,1.921；P<0.05)。重症HFMD患儿与普通型 HFMD患儿 IL-6、IL-10水平比较[(8.02±8.91)pg/mL vs (16.75±18.01)pg/mL,(23.17±10.06)pg/mL vs (11.86±7.01)pg/mL],差异均有统计学意义(t=1.792,4.739；P<0.05)。IL-6与 IgG、IgM有明显相关关系(r=0.411,0.899；P<0.05)；IL-10与 IgA 有明显相关关系(r=-0.325,P<0.05)。IL-6与CD3、CD4水平有明显相关关系(r=0.720,0.764；P<0.05)。结论 HFMD患儿于发病初期即存在免疫功能紊乱,特别是 IgA 和 CD4+水平下降,并存在抗炎-促炎机制失衡,其水平变化可能是重症 H FMD患儿发病的重要原因之一。
목적탐토수족구병(HFMD)환인적종류배사인자(TNF)-α、백세포개소(IL)-6、IL-10급면역공능적변화。방법선택2012년5월지10월우산동성즉묵시인민의원인과수족구병문진취진급주원치료적수차학진위 H FMD환인56례위연구대상,병장기납입실험조。수궤선택동기우본원행건강체검적20례건강인동납입대조조。량조인동적성별、년령등일반림상자료비교,차이무통계학의의(P>0.05)。검측량조인동면역구단백(Ig)A、IgG、IgM,T 림파세포아군(CD3+、CD4+、CD8+、CD4+/CD8+)급혈청TNF-α、IL-6、IL-10수평(본연구준순적정서부합산동성즉묵시인민의원인체시험위원회제정적윤리학표준,득도해위원회비준,분조정득수시대상감호인적지정동의,병여지첨서림상연구지정동의서)。결과실험조여대조조 IgA、CD4+、IL-6、IL-10수평비교[(1.06±0.61)g/L vs (1.50±0.54)g/L,(30.79±8.87)%vs (35.15±5.18)%,(14.71±16.29)pg/mL vs (3.76±1.03)pg/mL,(15.38±8.77) pg/mL vs (11.39±4.99)pg/mL],차이균유통계학의의(t=2.849,2.070,2.991,1.921；P<0.05)。중증HFMD환인여보통형 HFMD환인 IL-6、IL-10수평비교[(8.02±8.91)pg/mL vs (16.75±18.01)pg/mL,(23.17±10.06)pg/mL vs (11.86±7.01)pg/mL],차이균유통계학의의(t=1.792,4.739；P<0.05)。IL-6여 IgG、IgM유명현상관관계(r=0.411,0.899；P<0.05)；IL-10여 IgA 유명현상관관계(r=-0.325,P<0.05)。IL-6여CD3、CD4수평유명현상관관계(r=0.720,0.764；P<0.05)。결론 HFMD환인우발병초기즉존재면역공능문란,특별시 IgA 화 CD4+수평하강,병존재항염-촉염궤제실형,기수평변화가능시중증 H FMD환인발병적중요원인지일。
Objective To investigate the changes of tumor necrosis factor (TNF)-α,interleukin (IL)-6,IL-10 and immun functions of children with hand,foot and mouth disease (HFMD).Methods Fifty-six out-patients and in-patients who were diagnosed as HFMD in the department of Pediatrics,People′s Hospital of Jimo City from May to October 2012,were included into this study as experiment group.At the same time,another 20 healthy children were recruited into this study as control group.There were no significant differences on age and gender between two groups (P>0.05).The levels of following items were detected of two groups:immunoglobulin (Ig)A,IgG,IgM,T cell subgroup (CD3 +,CD4 +,CD8 +,CD4 +/CD8 +)and cytokines(TNF-α,IL-6,IL-10).The study protocol was approved by the Ethical Review Board of Investigation of People′s Hospital of Jimo City.Informed consent was obtained from all participates′patients.Results The significant differences were found in the levels of IgA,CD4 +,IL-6 and IL-10 between experiment group and control group [(1.06±0.61)g/L vs (1.50±0.54)g/L,(30.79±8.87)%vs (35.15±5.18)%,(14.71±16.29)pg/mL vs (3.76±1.03)pg/mL,(15.38±8.77)pg/mL vs (11.39±4.99)pg/mL](t=2.849,2.070,2.991,1.921;P<0.05).There were significant differences in IL-6,IL-10 between severe HFMD patients and common HFMD patients [(8.02 ± 8.91 )pg/mL vs (16.75±18.01)pg/mL,(23.17±10.06)pg/mL vs (11.86±7.01)pg/mL](t=1.792,4.739;P<0.05). There was a positive correlation between IL-6 and IgG,IgM (r=0.411,0.899;P<0.05),IL-10 and IgA (r=-0.325,P<0.05),IL-6 and CD3 ,CD4 (r=0.720,0.764;P<0.05).Conclusions The immune function disorder was found at the early stage of HFMD,especially the decline of IgA and CD4 + levels. Furthermore,the inflammatory and antiinflammatory mechanism disorder may play an important role in the development of severe HFMD.