反复呼吸道感染儿童中医体质分析及其与免疫功能、维生素A的关系探讨

Analysis on Traditional Chinese Medicine Constitution and Its Relationship with Immune Function and Vitamin A for Children with Recurrent Respiratory Tract Infection

目的:分析反复呼吸道感染(RRTI)儿童中医体质分布及其与免疫功能、维生素A的关系。方法:选取2020年6月~2021年6月医院收治RRTI儿童141例作为RRTI组,另选取体检健康儿童76例作为健康组,比较幼儿中医体质类型分布情况,免疫散射比浊法检测外周血IgA、IgG、IgM水平,流式细胞法检测外周血CD3^(+)、CD3^(+)CD4^(+)、CD4^(+)/CD8^(+)水平,微量荧光法检测外周血维生素A水平,比较幼儿IgA、IgG、IgM、CD3^(+)、CD3^(+)CD4^(+)、CD4^(+)/CD8^(+)和维生素A水平,多因素logistics回归分析RRTI的影响因素,spearman相关性分析维生素A水平与免疫功能指标关系。结果:RTI组气阴两虚型、脾肺两脏气虚型、积滞蕴热型占比高于健康组(P<0.05),IgG、IgA、IgM、CD3^(+)、CD3^(+)CD4^(+)、CD4^(+)/CD8^(+)水平和维生素A水平均低于健康组(P<0.001)。积滞蕴热型组、脾虚肝旺型组外周血IgA、IgG水平均高于气阴两虚型组(P<0.05),脾肺两脏气虚型组、积滞蕴热型组、脾虚肝旺型组儿童的外周血CD3^(+)、CD3^(+)CD4^(+)水平均显著高于气阴两虚型组(P<0.05),积滞蕴热型组、脾虚肝旺型组儿童的外周血CD4^(+)/CD8^(+)水平均显著高于气阴两虚型组(P<0.05),脾虚肝旺型组儿童的外周血CD3^(+)CD4^(+)水平高于脾肺两脏气虚型组(P<0.05),外周血维生素A水平与IgA、CD3^(+)、CD3^(+)CD4^(+)、CD4^(+)/CD8^(+)呈正相关(r=0.368、0.426、0.409、0.324,P<0.001)。结论:RRTI患儿中医体质以气阴两虚型、脾肺两脏气虚型、积滞蕴热型为主,且气阴两虚型、脾肺两脏气虚型、CD3^(+)(<62%)、维生素A(<0.92μmol/L)是儿童RRTI独立危险因素,维生素A水平与免疫功能存在相关性。

Objective:To analyze the distribution of TCM constitution and its relationship with immune function and vitamin A in children with recurrent respiratory tract infection(RRTI).Methods:A total of 141 children with RRTI admitted to the hospital were enrolled as RRTI group between June 2020 and June 2021,while other 76 healthy children undergoing physical examination were enrolled as a healthy group.The types constitution of TCM constitution in infants was compared.The levels of peripheral blood IgA,IgG and IgM were detected by immuno-scatter turbidmetry.The levels of peripheral blood CD3^(+),CD3^(+)CD4^(+)and CD4^(+)/CD8^(+)were detected by flow cytometry.The level of peripheral blood vitamin A was detected by micro-fluorescence method.The levels of IgA,IgG,IgM,CD3^(+),CD3^(+)CD4^(+),CD4^(+)/CD8^(+)and vitamin A in infants were compared.The influencing factors of RRTI were analyzed by multivariate Logistic regression analysis.The relationship between vitamin A and immune function indexes was analyzed by spearman correlation analysis.Results:The proportions of cases with Qi-Yin deficiency type,spleen-lung Qi deficiency type and stagnation intrinsic heat type in the RRTI group were higher than those in the healthy group(P<0.05),while levels of IgA,IgG,IgM,CD3^(+),CD3^(+)CD4^(+),CD4^(+)/CD8^(+)and vitamin A were lower than those in the healthy group(P<0.001).The levels of peripheral blood IgA and IgG in the stagnation intrinsic heat type group and the spleen-deficiency liver hyperactivity type group were higher than those in the Qi-Yin deficiency type group(P<0.05).The levels of peripheral blood CD3^(+)and CD3^(+)CD4^(+)in the spleen-lung Qi deficiency type group,the stagnation intrinsic heat type group and the spleen-deficiency liver hyperactivity type group were significantly higher than those in the Qi-Yin deficiency type group(P<0.05).The level of peripheral blood CD4^(+)/CD8^(+)in the stagnation intrinsic heat type group and the spleen-deficiency liver hyperactivity type group was significantly higher than that in Qi-Yin deficiency type group(P<0.05).The level of peripheral blood CD3^(+)CD4^(+)in the spleen-deficiency liver hyperactivity type group was higher than that in the spleen-lung Qi deficiency type group(P<0.05).Qi-Yin deficiency type,spleen-lung Qi deficiency type,CD3^(+)(<62%)and vitamin A(<0.92μmol/L)were independent risk factors of RRTI.The level of peripheral blood vitamin A was positively correlated with IgA,CD3^(+),CD3^(+)CD4^(+)and CD4^(+)/CD8^(+)(r=0.368,0.426,0.409,0.324,P<0.001).Conclusion:The main types of TCM constitution include Qi-Yin deficiency type,spleen-lung Qi deficiency type and stagnation intrinsic heat type in RRTI children.Qi-Yin deficiency type,spleen-lung Qi deficiency type,CD3^(+)(<62%)and vitamin A(<0.92μmol/L)are independent risk factors of RRTI.There is correlation between vitamin A and immune function.