手足口病患儿细胞免疫功能与相关细胞因子水平变化的临床研究

Clinical study on changes of cellular immune function and cytokine levels in children with HFMD

目的分析手足口病(HFMD)患儿循环血T淋巴细胞亚群、NK细胞及细胞因子水平变化及意义。方法回顾性分析2016年1月—2018年6月在川北医学院附属医院就诊的68例HFMD患儿,分析其治疗前后细胞免疫功能与相关细胞因子水平变化,探讨其与病情程度的关系。结果68例HFMD患儿作为观察组,该院健康体检儿童25例作为对照组。观察组以单一病毒感染最为常见,肠道病毒71(EV-71)构成比最高(47.06%),其次为EV-71+CA16的(14.71%)。观察组治疗前CD4+T、CD8+T、NK细胞水平低于对照组(P<0.05);观察组白细胞介素-10(IL-10)、白细胞介素-17(IL-17)及肿瘤坏死因子-α(TNF-α)水平高于对照组(P<0.05)。重型HFMD组治疗前CD4+T、CD8+T水平低于普通型HFMD组(P<0.05),而NK细胞水平高于普通型HFMD组(P<0.05);重型HFMD组IL-10、IL-17及TNF-α高于普通型HFMD组(P<0.05)。观察组患儿治疗7 d后CD4+T、CD8+T及NK细胞水平较治疗前高(P<0.05),而治疗后IL-10、IL-17及TNF-α水平较治疗前低(P<0.05)。结论HFMD发生机制与机体细胞免疫功能异常和相关细胞因子水平失衡相关,并对疾病的发生、发展、病情评估及转归有重要指导作用。

Objective To analyze changes and significance of T lymphocyte subsets,NK cells and cytokine levels in circulating blood of children with hand foot and mouth disease(HFMD).Methods Retrospective analysis was used to analyze the changes and significance of cellular immune function and related cytokine levels before and after treatment in 68 children with hand-foot-mouth disease admitted to the hospital from January 2016 to June 2018,and to explore the relationship between the changes and the severity of the disease.Results Among the 68 children with HFMD as observation group and 25 healthy children as control group,single virus infection was the most common.The Enterovirus 71(EV71)infection appeared the highest(47.06%),followed by EV71+CA16 mixed infection(14.71%).The levels of CD4+T,CD8+T and NK cells in the observation group were lower than those in the control group(P<0.05).The leukin-10(IL-10),interleukin-17(IL-17)and Tumor necrosis factor(TNF-α)levels in the observation group were significantly higher than those in the control group(P<0.05).Before treatment,CD4+T and CD8+T levels in the severe HFMD group were lower than those in the normal HFMD group(P<0.05),and NK cell levels were higher than those in the normal HFMD group(P<0.05).IL-10,IL-17 and TNF-αwere all higher in the heavy HFMD group than in the normal HFMD group(P<0.05).The levels of CD4+T,CD8+T,and NK cells in the observation group were all higher after 7 days of treatment than before(P<0.05),and the levels of IL-10,IL-17,and TNF-αwere lower after treatment than before(P<0.05).Conclusions The pathogenesis of children with HFMD is related to the abnormality of cellular immune function and the imbalance of cytokines,which plays a guiding role in the occurrence,development,evaluation and outcome of the disease.