CAJ | 학술논문

目的：观察儿童病毒性脑炎治疗前后外周血淋巴细胞亚群的变化，探讨外周血淋巴细胞亚群的变化对重症病毒性脑炎预后判断的意义。方法选取23例重型病毒性脑炎患儿为研究对象，以重型病毒性脑炎患者年龄及性别为依据，1∶1配对选取轻型病毒性脑炎及正常体检儿童组成轻症组及对照组；流式细胞仪检测治疗前后外周血淋巴细胞亚群百分比；轻型病毒性脑炎按脑炎常规治疗，重型者在常规治疗同时应用甲强龙冲击治疗+大剂量IVIG治疗；以出院时无明显神经系统异常归为预后良好组，仍遗留各种神经系统功能障碍或死亡者归为预后不良组。结果重症组CD3+、CD4+T淋巴细胞百分比、CD4/CD8值较轻型组与对照组明显减低（P＜0.01）；重型组CD8+T、CD19+B淋巴细胞百分比较轻型组与对照组显著升高（ P＜0.01）；CD16+、CD56+、NK细胞百分比各组之间差异无统计学意义。重型组预后良好者CD8+T细胞百分比治疗后明显低于治疗前（P＜0.01）；CD19+B细胞百分比明显低于治疗前（P＜0.01）；预后差组治疗前后CD8+T、CD19+B细胞百分比无明显差别（P＞0.05）。结论重症病毒性脑炎患儿存在T细胞和B细胞免疫功能紊乱；治疗后CD8+T细胞百分比、CD19+B细胞百分比无明显变化提示预后不良，甲强龙冲击+大剂量IVIG治疗可能影响CD8+T细胞及CD19+B细胞百分比。
목적：관찰인동병독성뇌염치료전후외주혈림파세포아군적변화，탐토외주혈림파세포아군적변화대중증병독성뇌염예후판단적의의。방법선취23례중형병독성뇌염환인위연구대상，이중형병독성뇌염환자년령급성별위의거，1∶1배대선취경형병독성뇌염급정상체검인동조성경증조급대조조；류식세포의검측치료전후외주혈림파세포아군백분비；경형병독성뇌염안뇌염상규치료，중형자재상규치료동시응용갑강룡충격치료+대제량IVIG치료；이출원시무명현신경계통이상귀위예후량호조，잉유류각충신경계통공능장애혹사망자귀위예후불량조。결과중증조CD3+、CD4+T림파세포백분비、CD4/CD8치교경형조여대조조명현감저（P＜0.01）；중형조CD8+T、CD19+B림파세포백분비교경형조여대조조현저승고（ P＜0.01）；CD16+、CD56+、NK세포백분비각조지간차이무통계학의의。중형조예후량호자CD8+T세포백분비치료후명현저우치료전（P＜0.01）；CD19+B세포백분비명현저우치료전（P＜0.01）；예후차조치료전후CD8+T、CD19+B세포백분비무명현차별（P＞0.05）。결론중증병독성뇌염환인존재T세포화B세포면역공능문란；치료후CD8+T세포백분비、CD19+B세포백분비무명현변화제시예후불량，갑강룡충격+대제량IVIG치료가능영향CD8+T세포급CD19+B세포백분비。
Objective To observe the changes of peripheral blood lymphocyte subsets in children with viral encephalitis before and after treatment;to study the significant of the prognosis of the changes of peripheral blood lymphocyte subsets. Methods 23 cases of severe viral encephalitis children were selected as the research object,according to the age and sex,1:1 light viral encephalitis and normal children composition and the control group before and after treatment in mild group;detection of peripheral blood lymphocyte subsets and the percentage of flow cytometry;light viral encephalitis by encephalitis conventional treatment,heavy application of methylprednisolone therapy with high-dose IVIG treatment at the same time in the conventional treatment;at discharge with no obviousneurological abnormalities into good prognosis group,still left over various neurological dysfunction or deathattributed to the poor prognosis group. Results The percentage of CD3+,CD4+T lymphocyte,CD4/CD8 value of the severe group was significantly lower than that of the light group and the control group(P<0.01);The percentage of CD8+T,CD19+B lymphocyte in severe group increased significantly more than that of the light group and the control group(P < 0.01);no statistical differences between the percentages of CD16+,CD56+,NK cells in each group.The severe group have good outcome and the percentage of CD8+T cells after treatment was significantly lower than that before treatment(P < 0.01);the percentage of CD19+B cells was significantly lower than that before treatment (P<0.01);the percentage of CD8+T,CD19+B cells of the poor prognosis group had no significant difference between before and after treatment(P>0.05). Conclusion T cell and B cell immune function disorder exists in children with severe viral encephalitis;after treatment,the percentage of CD8+T cell and CD19+B cells had no obvious change indicates a poor prog nosis,methylprednisolone+high dose IVIG treatment may affect the percentage of CD8+T cells and CD19+B cells.