地塞米松、γ-干扰素对毛细支气管炎患儿免疫调节作用的观察

Dexamethasone and IFN-γ on the function of T_H1/T_H2 in children with lower respiratory tract infections.

目的观察地塞米松、γ干扰素对毛细支气管炎患儿T细胞细胞免疫和T细胞体液免疫比值(TH1/TH2)的作用。方法将60例2002年11月至2004年4月在青岛市第八人民医院儿科住院的毛细支气管炎患儿,按入院顺序分成地塞米松组和γ干扰素组,并选择15例健康婴儿为正常对照组。检测毛细支气管炎患儿治疗前血清IgE水平及细胞因子IFNγ、IL4水平,然后分别用地塞米松、γ干扰素治疗,出院时复查血清IgE、IFNγ及IL4水平。结果正常对照组和毛细支气管炎组血清IgE水平及细胞因子IFNγ、IL4、IFNγ/IL4水平差异有非常显著意义(P<0.001)。γ干扰素组和地塞米松组治疗前血清IgE和细胞因子IFNγ、IL4、IFNγ/IL4差异均无显著性意义(P>0.05),但治疗后,以上指标差异均有非常显著意义(P<0.001)。出院后随访12个月,统计喘息反复发生的例数,γ干扰素组3例,地塞米松组10例,经卡方检验差异有显著意义(P<0.05)。结论毛细支气管炎患儿血清IgE水平高,TH1/TH2失衡。地塞米松短期内可起到抗炎、平喘作用,止喘起效快,但T1/T2治疗前后无差异,反复感染、喘息反复出现、容易发展成婴幼儿哮喘。

Objective To observe the effect of dexamethasone and IFN-γ on the function of T_H1/T_H2 in lower respiratory tract infections.Methods Sixty patients with lower respiratory tract infections were divided randomly into 2 groups:group I with dexamethasone treatment,group II with IFN-γ treatment.Normal group of 15 cases was as control.Serum levels of IgE,IFN-γ and IL-4 were detected before and after treatment.Results Compared with normal control,there was significant difference in the serum level of IgE,IFN-γ,IL-4,IFN-γ/IL-4 in group Ⅰ and group Ⅰ,P<0.001.There was no difference in the serum level of IgE,IFN-γ,IL-4,IFN-γ/IL-4 between group I and group Ⅱ before treatment(P>0.05).But there was significant difference after treatment(P<0.001).After being followed up for 12 months,3 cases suffered from asthma in group Ⅰ,10 cases in group Ⅱ.There were outstanding meanings by square examination,P<0.05.Conclusion In patients with lower respiratory tract infections,the serum level of IgE rises.Humoral immunity is relatively increased and cell immunity decreased.So the T_H1/T_H2 is out of balance.With the treatment of dexamethasone,the body’s immune system is suppressed.In short time,the infection and asthma can be controlled,but T_H1/T_H2 can’t change after treatment.IFN-γ can interfere the duplication of virus,increase the level of IFN-γ in body,furthermore it can strengthen the cell immune function,lower cell immunologial answer of T_H2 and recover the balance of T_H1/T_H2 The follow-up suggests IFN-γ has an important meaning in preventing infant asthma.