反复呼吸道双重感染患儿的免疫学特征

Immunological Manifestation of Children with Recurrent Respiratory Tract Inflammation Caused by Superinfection

目的研究柯萨奇B组病毒(CVB)及肺炎支原体(MP)双重感染对反复呼吸道感染(RRI)小儿免疫学特征的影响。方法选择RRI住院患儿132例。根据MP-IgM抗体及CVB特异性IgM抗体检测结果分为阴性对照组、MP感染组、CVB感染组及双重感染组。4组均测定ESR、CRP;采用酶联免疫吸附试验(ELISA)测定CVBIgM抗体;采用琼脂单向扩散法定量测定IgG、IgA、IgM;流式细胞仪检测外周血T细胞亚群。结果CVB感染主要见于1～3岁患儿,阳性率为32.1%;MP感染主要见于3岁以上患儿,阳性率为22.7%;双重感染10例,占患儿总数的7.6%。CVB及MP双重感染组IgG有升高趋势,IgA有下降趋势,双重感染组IgM较阴性对照组及MP感染组明显升高(Pa<0.05)。各组T细胞亚群中CD3比例无明显差异;MP感染组及双重感染组CD4较阴性对照组明显降低(Pa<0.05);4组CD8无显著差异;CD4/CD8值双重感染组较阴性对照组明显下降(P<0.05)。CVB感染组NK细胞较阴性对照组明显升高(P<0.05)。结论CVB及MP感染均使RRI患儿体液及细胞免疫调节功能紊乱,双重感染使上述免疫失衡加重。

Objective To investigate the influence of coxsackie B virus （CVB） and mycoplasma pneumoniae （MP） superinfection on immunological manifestation of recurrent respiratory tract inflammations（RRI） in children. Methods One hundred and thirty - two hospitalized children with RRI between Jan. to Dec. 2005 were divided into negative control group, MP infection group, CVB infection group and superintection group by determining anti - MP IgM and anti - CVB IgM. Blood sedimentation, C - reactive protein, IgG, IgA, IgM and T lymphocyte sub- population etc. were determined in four groups. The anti - MP IgM was determined by specificity immune agglutination test. Enzyme linked immunosorbent assay was used to detect anti - CVB IgM. The IgG,IgA, IgM were determined by simple agar diffusion method. T lymphocyte subpopulation was tested by flow cytometry. Results The percentage of CVB infection was 32.1%, mainly expressed in the 1 - 3 years old children;the percentage of MP infection was 22.7% ,mainly expressed in children over 3 years old. In both CVB and MP infection group,the tendency of IgG increased and that of IgA decreased. IgM in the CVB and MP superinfection group was obviously higher than that in negative control group and MP infection group （ Pa 〈 0. 05 ）. The CD3 proportion of T lymphotcyte subpopulation in every group was not obviously different. The CD4 proportion of MP infection and superinfection group was obviously lower than that in negative control group （ P 〈 0. 05 ）. The CD8 proportion was not obviously different in four groups. CD4/CD8 in superinfection group was obviously lower than that in negative control group （ 1.57 ±0. 09 vs 1.99 ±0. 01 P 〈 0. 05 ）. NK of CVB infection group was obviously higher than that in negative control group （ P 〈 0. 05 ）. Conclusions CVB and MP infection disorder immunomodulation function of the humoral and cellular immunity in children with respiratory tract inflammation. Superinfection promote immune disequilibrium more seriously.