细胞因子水平改变在婴儿巨细胞病毒感染中的临床意义

Changes of serum cytokines and their clinical significance in infants with cytomegalovirus infection

目的了解巨细胞病毒(cytomegalovirus,CMV)感染婴儿血清TNF-α、IFN-γ、IL-4水平变化,探讨其在炎症发生过程中的作用。方法41例CMV-IgM阳性、其他疾病组和30例CMV-IgM阳性、肝炎组作为观察对象,30例健康婴儿作为对照(对照组),ELISA法检测血清TNF-α、IFN-γ、IL-4,并分析TNF-α和ALT的相关性。结果与对照组相比,两组CMV-IgM阳性患儿TNF-α、IFN-γ、IL-4均高于对照组,IFN-γ/IL-4值显著低于对照组。肝炎组与其他疾病组相比较,TNF-α、IL-4、IFN-γ/IL-4值的改变具有显著性差异,且肝炎组TNF-α和ALT值呈显著正相关(r=0.76,P<0.01),而IFN-γ在其他疾病组和肝炎组增高均不明显。结论CMV感染后导致患儿细胞因子分泌紊乱,表现为TNF-α水平增高,且与肝功能损害的程度密切相关;同时IFN-γ/IL-4值变化则提示由于Th2功能异常增高而导致Th1和Th2平衡失调。该研究结果对于阐明CMV感染的发病机制,改善CMV感染的防治措施提供了免疫学依据。

Objective To investigate the changes of serum cytokines and explore their role in infants with cytomegalovirus （CMV） infection. Methods We recruited 41 positive CMV-IgM plus normal ALT infants （other disease group）, 30 positive CMV-IgM plus abnormal ALT infants （hepatitis group） and 30 healthy infants （ control group） in the study. The levels of tumor necrosis factor-α （ TNF-α）, interferon-γ （IFN-γ） and interleukin-4 （IL-4） in serum were measured with ELISA. The association between TNF-α and ALT was analyzed. Results The levels of TNF-α, IFN-γ, IL-4 were higher, and IFN-γ/IL-4 was significantly lower in the two CMV infection groups than the control group. Compared with other disease group, the changes of TNF-α, IL-4, and IFN-γ/IL-4 showed significance in hepatitis group. The level of TNF-α showed a positive association with ALT in hepatitis group（r = 0. 76,P 〈 0. 01 ）, but IFN-γ increased slightly in both groups. Conclusion Abnormal cytokines secretion is corroborated in CMV-infected infants exhibited by the high levels of TNF-α as well as a close correlation with the inflammation extent. The changes of IFN-γ/IL-4 suggest the imbalance of Th1/Th2 induced by the abnormal elevation of Th2. The conclusion will provide the immunological basis to clarify the pathogenesis of CMV infection and improve the prevention and cure measures.