CAJ | 학술논문

目的：研究传染性单核细胞增多症（ IM ）患儿的外周血T细胞亚群的变化及更昔洛韦的干预作用。方法选取2010年1月至2014年1月期间温州医科大学附属育英儿童医院儿科收治的82例传染性单核细胞增多症患儿作为研究对象，将患儿随机分为两组，其中41例患儿在对症治疗基础上使用α－干扰素（ IFN-α）治疗，为对照组，另外41例在对症治疗基础上应用IFN-α和更昔洛韦治疗，为观察组。选取同一时期的健康儿童50例作为空白组，比较各组外周血淋巴细胞亚群分布的变化。比较观察组和对照组患儿的EB病毒壳抗原IgM抗体（ EB-VCA-IgM）转阴率、治疗有效率和不良反应发生率。结果与空白组相比，观察组和对照组患儿治疗前CD3＋和CD8＋比例升高，CD4＋比例和CD4＋／CD8＋降低，差异均具有统计学意义（ F值分别为7．098、8．678、5．789、6．987，均P＜0．05）。治疗后，观察组的CD3＋和CD8＋比例低于对照组，CD4＋比例和CD4＋／CD8＋高于对照组，差异均具有统计学意义（t值分别为7．61、8．12、10．12、5．77，均P＜0．05）。观察组和对照组患儿治疗1个月和3个月的EB-VCA-IgM转阴率均具有统计学差异（χ2值分别为5．917和10．686，均P＜0．05），治疗7天和6个月的EB-VCA-IgM转阴率具无统计学差异（χ2值分别为0．988和0．534，均P＞0．05）。观察组治疗有效率100．00％，对照组92．68％，差异具有统计学意义（P＜0．05）。观察组不良反应发生率9．76％，对照组4．88％，差异无统计学意义（χ2＝1．712，P＞0．05）。结论与健康儿童相比，传染性单核细胞增多症患儿的T细胞比例增加，CD4＋／CD8＋下降，细胞免疫出现异常。更昔洛韦的应用可以抑制病毒复制，促进细胞免疫功能的恢复，改善临床疗效。
목적：연구전염성단핵세포증다증（ IM ）환인적외주혈T세포아군적변화급경석락위적간예작용。방법선취2010년1월지2014년1월기간온주의과대학부속육영인동의원인과수치적82례전염성단핵세포증다증환인작위연구대상，장환인수궤분위량조，기중41례환인재대증치료기출상사용α－간우소（ IFN-α）치료，위대조조，령외41례재대증치료기출상응용IFN-α화경석락위치료，위관찰조。선취동일시기적건강인동50례작위공백조，비교각조외주혈림파세포아군분포적변화。비교관찰조화대조조환인적EB병독각항원IgM항체（ EB-VCA-IgM）전음솔、치료유효솔화불량반응발생솔。결과여공백조상비，관찰조화대조조환인치료전CD3＋화CD8＋비례승고，CD4＋비례화CD4＋／CD8＋강저，차이균구유통계학의의（ F치분별위7．098、8．678、5．789、6．987，균P＜0．05）。치료후，관찰조적CD3＋화CD8＋비례저우대조조，CD4＋비례화CD4＋／CD8＋고우대조조，차이균구유통계학의의（t치분별위7．61、8．12、10．12、5．77，균P＜0．05）。관찰조화대조조환인치료1개월화3개월적EB-VCA-IgM전음솔균구유통계학차이（χ2치분별위5．917화10．686，균P＜0．05），치료7천화6개월적EB-VCA-IgM전음솔구무통계학차이（χ2치분별위0．988화0．534，균P＞0．05）。관찰조치료유효솔100．00％，대조조92．68％，차이구유통계학의의（P＜0．05）。관찰조불량반응발생솔9．76％，대조조4．88％，차이무통계학의의（χ2＝1．712，P＞0．05）。결론여건강인동상비，전염성단핵세포증다증환인적T세포비례증가，CD4＋／CD8＋하강，세포면역출현이상。경석락위적응용가이억제병독복제，촉진세포면역공능적회복，개선림상료효。
Objective To study the changes of peripheral blood lymphocyte subsets in children with infectious mononucleosis and the interfere of Ganciclovir.Methods From January 2010 to January 2014, 82 children with infectious mononucleosis admitted in Yuying Children’ s Hospital of Wenzhou Medical University were chosen as study objects.All children were divided into two groups randomly, 41 in control group receiving IFN-αbased on symptomatic treatment and 41 in observation group accepting IFN-αand Ganciclovir based on symptomatic treatment.At the same time, 50 healthy children were chosen as blank group.The changes of peripheral blood lymphocyte subsets were compared among three groups.The negative rate of EB-VCA-IgM, effective rate and adverse reaction rate were compared between the observation group and the control group.Results Compared with the blank group, the ratios of CD3 +and ratio CD8 +in children with infectious mononucleosis were higher but the ratios of CD4 +and CD4 +/CD8+were lower in the observation group and control group before treatment, and the differences were significant (F value was 7.098, 8.678, 5.789 and 6.987, respectively, all P<0.05). After treatment, the ratios of CD3 +and ratio CD8 +were lower but the ratios of CD4 +and CD4 +/CD8 +were higher in observation group, and the differences were significant (t value was 7.61, 8.12, 10.12 and 5.77, respectively, all P<0.05).The negative rate of EB-VCA-IgM had significant difference between the observation group and the control group 1 month and 3 months after treatment (χ2 value was 5.917 and 10.686, respectively, both P<0.05) .But there was no significant difference between two groups after 7 days and 6 months, the difference had no statistical significant (χ2 value was 0.988 and 0.534, respectively, both P >0.05).The effective rate of the observation group and the control group was 100.00%and 92.68%, respectively with statistical significance (P<0.05).The incidence of adverse reactions was 9.76% and 4.88% in the observation group and the control group, respectively, and the difference was not significant (χ2 =1.712,P>0.05).Conclusion Compared with healthy children, those with infectious mononucleosis have increased ratio of T cells but decreased CD4 +/CD8 +, and cellar immunity is abnormal.The use of Ganciclovir can inhibit the virus replication of EB, promote the recovery of cellular immunity and thus improve clinical efficacy.