巨细胞病毒感染致婴幼儿喘息患儿中瘦素、CD4CD25Treg和TLR4的表达
거세포병독감염치영유인천식환인중수소、CD4CD25Treg화TLR4적표체
  • 万方数据
    中外健康文摘 중외건강문적
    WORLD HEALTH DIGEST
    2012年 51期 13-14 ,共2页

    朱春晖%陈强%朱庆雄%柯江维

    주춘휘%진강%주경웅%가강유



    目的巨细胞病毒(CMV)感染对婴幼儿喘息患儿瘦素、CD4+CD25+调节性T细胞数量及Toll样受体4(TLR4)的影响.方法69例婴幼儿喘息患儿作为观察组,28例健康儿童作为正常对照组,PCR法检测观察组和对照组痰及血CMV DNA水平,比较以上二组痰、血CMV-DNA阳性率；根据患儿CMV感染及是否使用更昔洛韦治疗情况,分为CMV感染更昔洛韦治疗组、非治疗组和非CMV感染组.放射免疫法检测患儿入院后24h内、治疗结束24h内及治疗后12周的血清瘦素水平,流式细胞仪检测外周血CD4+CD25+Treg细胞占CD4+T细胞百分比及外周血单核细胞表面TLR4的表达,并门诊或电话随访2年观察喘息发作次数.结果(1)69例婴幼儿喘息患儿中巨细胞病毒感染患儿37例(阳性率53.62%),明显高于正常对照组(1/28,3.57%)(p<0.01)；(2)37名婴幼儿喘息患儿痰CMV DNA为30,3769.8拷贝/ml,其中23例血CMV DNA阳性,spearman相关性分析r=0.047；(3)入院24h内：更昔洛韦治疗组、非更昔洛韦治疗组和非巨细胞病毒感染组血清瘦素水平均高于正常对照组(p<0.05), CD4+CD25+Treg百分比低于正常对照组(p<0.05)、TLR4高于正常对照组(p<0.01),差异有统计学意义；更昔洛韦治疗组、非更昔洛韦治疗组和非巨细胞病毒感染组组间瘦素水平、CD4+CD25+Treg百分比及TLR4水平均无明显差异(p>0.05).治疗结束24h内：更昔洛韦治疗组、非更昔洛韦治疗组和非巨细胞病毒感染组瘦素水平均较治疗前下降,组间无明显差异(p>0.05),更昔洛韦治疗后CD4+CD25+Treg百分比增高,差异有统计学意义(p<0.05),TLR4水平较治疗前明显下降(p<0.01),且低于同期非更昔洛韦治疗组TLR4水平(p<0.05).治疗后12周：更昔洛韦治疗组瘦素及TLR4水平低于非更昔洛韦治疗组和非巨细胞病毒感染组,CD4+CD25+Treg百分比高于非更昔洛韦治疗组和非巨细胞病毒感染组,差异有统计学意义(p<0.05)；非巨细胞病毒感染组瘦素水平、CD4+CD25+Treg百分比及TLR4水平与入院后24小时内及治疗结束24小时内比较无明显差异.(4)更昔洛韦治疗后随访2年患儿喘息次数明显减少(p<0.05).结论(1)巨细胞病毒感染与婴幼儿喘息有关,婴幼儿喘息患儿痰CMV DNA检测优于血CMV DNA检测；(2)CMV感染可能通过血清瘦素高水平表达、CD4+CD25+Treg数量的减少和TLR4表达增加及三者间相互作用导致Th1/Th2失衡,从而在婴幼儿喘息中发挥作用；(3)更昔洛韦治疗能有效减少CMV感染导致喘息发作次数.
    목적거세포병독(CMV)감염대영유인천식환인수소、CD4+CD25+조절성T세포수량급Toll양수체4(TLR4)적영향.방법69례영유인천식환인작위관찰조,28례건강인동작위정상대조조,PCR법검측관찰조화대조조담급혈CMV DNA수평,비교이상이조담、혈CMV-DNA양성솔；근거환인CMV감염급시부사용경석락위치료정황,분위CMV감염경석락위치료조、비치료조화비CMV감염조.방사면역법검측환인입원후24h내、치료결속24h내급치료후12주적혈청수소수평,류식세포의검측외주혈CD4+CD25+Treg세포점CD4+T세포백분비급외주혈단핵세포표면TLR4적표체,병문진혹전화수방2년관찰천식발작차수.결과(1)69례영유인천식환인중거세포병독감염환인37례(양성솔53.62%),명현고우정상대조조(1/28,3.57%)(p<0.01)；(2)37명영유인천식환인담CMV DNA위30,3769.8고패/ml,기중23례혈CMV DNA양성,spearman상관성분석r=0.047；(3)입원24h내：경석락위치료조、비경석락위치료조화비거세포병독감염조혈청수소수평균고우정상대조조(p<0.05), CD4+CD25+Treg백분비저우정상대조조(p<0.05)、TLR4고우정상대조조(p<0.01),차이유통계학의의；경석락위치료조、비경석락위치료조화비거세포병독감염조조간수소수평、CD4+CD25+Treg백분비급TLR4수평균무명현차이(p>0.05).치료결속24h내：경석락위치료조、비경석락위치료조화비거세포병독감염조수소수평균교치료전하강,조간무명현차이(p>0.05),경석락위치료후CD4+CD25+Treg백분비증고,차이유통계학의의(p<0.05),TLR4수평교치료전명현하강(p<0.01),차저우동기비경석락위치료조TLR4수평(p<0.05).치료후12주：경석락위치료조수소급TLR4수평저우비경석락위치료조화비거세포병독감염조,CD4+CD25+Treg백분비고우비경석락위치료조화비거세포병독감염조,차이유통계학의의(p<0.05)；비거세포병독감염조수소수평、CD4+CD25+Treg백분비급TLR4수평여입원후24소시내급치료결속24소시내비교무명현차이.(4)경석락위치료후수방2년환인천식차수명현감소(p<0.05).결론(1)거세포병독감염여영유인천식유관,영유인천식환인담CMV DNA검측우우혈CMV DNA검측；(2)CMV감염가능통과혈청수소고수평표체、CD4+CD25+Treg수량적감소화TLR4표체증가급삼자간상호작용도치Th1/Th2실형,종이재영유인천식중발휘작용；(3)경석락위치료능유효감소CMV감염도치천식발작차수.
    Objective The influence of cytomegalovirus infection on the leptin, CD4+CD25+ regulatory T cell and Toll-like receptor.Methods Using PCR to detect the phlegm and serum CMV DNA level of 69 wheezing infants and 28 healthy volunteers and compare the positive rates.detect the leptin level of cytomegalovirus infectious infants with radioimmunoassay in 24 hours after admission, 24 hours after ganciclovir treatment and 12 weeks after the treatment,the CD4+CD25+Treg percentage of CD4+T in peripheral blood and TLR4 expression in monocytes cell surface with flow cytometry.follow-up the wheezing in out - patient clinic or through phone call.Results (1)37 of wheezing infants suffered cytomegalovirus infection,the positive rates was 53.62%,was much higher than that in healthy volunteers group(1/28,3.57%)(p<0.01);(2)the phlegm CMV DNA in 37 wheezing infants was 30,3769.8copies/ml, serum CMV DNA was positive in 23 case, Spearman's correlation analysis suggest r=0.047;(3)24h after admission the serum leptin level in the group accepted ganciclovir treatment, the group refused ganciclovir treatment and group non- cytomegalovirus infection was higher than that in healthy volunteers group (p<0.05),the CD4+CD25+Treg percentage was lower than that in healthy volunteers group(p<0.05),the TLR4 level was higher than that in healthy volunteers group (p<0.05); ,the leptin level, CD4+CD25+Treg percentage, TLR4 level in the group accepted ganciclovir treatment, the group refused ganciclovir treatment and group non- cytomegalovirus infection has no significant difference(p>0.05).24h after the treatment:the leptin and TLR4 level in the group accepted ganciclovir treatment, the group refused ganciclovir treatment and group non- cytomegalovirus infection was lower than that before treatment,the level among the three groups has no significant difference(p>0.05); the CD4+CD25+Treg percentage increased after treatment(p<0.05); the TLR4 level in the group accepted ganciclovir treatment was lower than that in the group refused ganciclovir treatment(p<0.05);12 weeks after treatment: the leptin and TLR4 level in the group accepted ganciclovir treatment was lwer than that in the group refused ganciclovir treatment and group non- cytomegalovirus infection,the CD4+CD25+Treg percentage was higher(p<0.05),the leptin level in the group refused ganciclovir treatment,the CD4+CD25+Treg percentage and the TLR4 level has no significant difference with that in 24h after admission and in 24h after treatment.(4) the wheezing frequency was markedly reduced during the 2-year follow-up after treatment(p<0.05).Conclusions (1)cytomegalovirus infection is apparently related to wheezing,the phlegm CMV DNA detection is better than serum CMV DNA in weezing infants.(2)cytomegalovirus infection plays roles in Th1/Th2 imbalancing,which leads to wheezing -probably through the increase of leptin and TLR4 level ,the reduce of the CD4+CD25+Treg percentage and their interaction.(3)ganciclovir treatment can effectively reduce the wheezing frequency induced by the cytomegalovirus infection.
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