毛细支气管炎与支气管哮喘患儿血T淋巴细胞亚群表达异同

Difference of T Lymphocyte Subsets Expression in Blood of Children with Bronchiolitis or Asthma

目的了解毛细支气管炎与支气管哮喘患儿辅助性T淋巴细胞亚群表达的异同。方法毛细支气管炎组34例。男20例,女14例;年龄1～15(6.65±4.22)个月。经鼻咽部分泌物间接免疫荧光和(或)病毒血清IgM抗体检测证实,均为病毒感染所致,其中呼吸道合胞病毒23例,副流感、流感各4例,腺病毒3例。患儿双肺均可闻及不同程度的喘鸣音及中细湿啰音,均有不同程度发热(其中<38℃20例、38～39℃12例、>39℃2例);入院时末梢血白细胞多数正常。同期住院的支气管哮喘发作期患儿(支气管哮喘组)21例。男12例,女9例;年龄3～13(8.05±2.85)岁。对二组患儿均采用流式细胞仪收获细胞,并对其外周血T淋巴细胞亚群进行检测,检测CD4+细胞群中只分泌IFN-γ或IL-4细胞的百分数,分别代表辅助性T淋巴细胞Th1及Th2的百分数。结果毛细支气管炎组CD4+细胞百分率及CD4/CD8比值较支气管哮喘组高,差异有统计学意义(Pa=0.002);毛细支气管炎组与支气管哮喘组比较Th1细胞百分率无统计学差异,但Th2细胞百分率却较支气管哮喘组明显降低,差异有统计学意义(P=0),而Th1/Th2比值显著高于支气管哮喘组有统计学差异(P=0.031)。结论与支气管哮喘相比,毛细支气管炎患者呈现相对的Th1优势反应,二者的治疗策略也必然有所不同。

Objective To understand the difference of helpful T lymphocyte subsets in patients diagnosed with bronchiolitis or asthma. Methods There were 34 patients in bronchiolitic group including 20 males and 14 females, the age of the patients was 1 - 15 （6.65±4.22） months. They were confirmed by indirect immunofluorescence of nasopharyngeal secretion and （or） virus IgM antibody detected in plasma. All of the patients were infected with virus ,23,4,4 ,and 3 patients were infected with respiratory syncytial virus,parainfluenza virus, influenza vires and adenovirus, respectively. All patients showed wheeze and small to medium blistering sound to different extend in both lungs,and all pa- tients got fever at various degrees （20 patients blow 38℃, 12 patients at 38 -39℃ and 2 patients above 39℃ ）. The patients＇ capillary white cell counts were relatively normal when they were admitted to the hospital. There were 21 patients in asthmatic group including 12 male and 9 female, the age of the patients was 3 - 13 （ 8.05 ± 2.85 ） years. Blood cells of 34 patients with bronchiolitis and 21 patients with asthma were collected by flow cytometry, and their peripheral T lymphocyte subsets were analyzed. The percentages of CD4＋ cells secreting IFN - γ or IL - 4 were counted. They represented the percentage of helpful T lymphocyte Thl and Th2,respectively. Results The percentage of CD4 positive cells and the ratio of CD4/CD8 were significantly higher in the bronehiolitic group than that in the asthmatic group （P =0. 002）. There was no significant difference of the percentage of Thl cells between 2 groups. The percentage of Th2 cells in the bronchiolitic group ,however,was significantly lower than that of the asthmatic group （P =0）. Thus the Th1/Th2 ratio was significantly higher in the bronchiolitic group （P = 0. 031 ）. Conclusions Compared with asthmatic patients, the patients with bronchiolitis show relative Thl predominant response. Therefore, the treatment strategy should be different for these 2 diseases.