儿童传染性单核细胞增多症T细胞亚群及B细胞的动态变化研究

Dynamic Changes of T Lymphocyte Subset and B Cells in Children With Infectious Mononucleosis Caused by Epstein-Barr Virus

目的探讨儿童传染性单核细胞增多症(infectious mononucleosis,IM)不同时期外周血T细胞亚群CD3+,CD4+CD8+细胞及B细胞CD19+,CD19+和CD23+的改变及其变化规律。方法选择2006年3月至2008年3月四川省人民医院儿科收治的30例传染性单核细胞增多症患儿为研究对象(研究组,n=30),选择同期入托体检,无过敏性疾病史及无阳性过敏疾病家族史的健康儿童纳入对照组(n=25)(本研究遵循的程序符合四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书)。两组儿童性别、年龄比较,差异无显著意义(P>0.05)。研究组分别在传染性单核细胞增多症急性期,病程1个月、3个月、6个月时,采集静脉血2 mL,对照组采血方式与研究组相同,采用肝素抗凝、流式细胞术方法分别检测其外周血淋巴细胞CD3+,CD4+,CD8+和CD19+及CD19+CD23+表达率,并进行比较。结果①研究组急性期CD4+为(14.84±5.03)%,CD4+/CD8+为(0.25±0.13)%,CD19+为(3.89±1.32)%及CD19+CD23+为(0.24±0.13)%,较对照组明显降低;CD3+为(82.55±5.49)%,CD8+为(66.17±8.10)%,较对照组明显增高,与其余各组比较,差异有显著意义(P<0.001);②研究组内随时间推移及感染的控制,CD4+,CD4+/CD8+,CD19+及CD19+CD23+逐渐升高,CD3+,CD8+细胞逐渐降低;③研究组病程6个月时,CD3+为(67.98±8.01)%、CD4+为(32.81±6.79)%、CD8+为(33.96±7.37)%、CD4+/CD8+为(0.93±0.31)%及CD19+CD23+为(1.30±0.50)%,与对照组比较,差异无显著意义(P>0.05),但病程6个月时,CD19+为(14.60±4.80)%,与对照组比较,差异有显著意义(P<0.001)。结论单核细胞增多症急性期CD3+,CD8+明显增高,CD4+,CD4+/CD8+,CD19+及CD19+,CD23+明显降低,病程6个月时,CD3+,CD4+,CD8+,CD4+/CD8+及CD19+CD23+表达正常,但CD19+仍低于正常水平。这提示,单核细胞增多症患儿存在继发性免疫功能低下,并持续至临床症状消失后较长时间,应引起重视。该结果可为临床应用静脉丙种球蛋白治疗单核细胞增多症提供一定理论依据。

Objective To study the dynamic changes of T lymphocyte subset and B cell in children with infectious mononucleosis（IM） caused by Epstein-Barr virus （EBV）. Methods From March 2006 to March 2008, 30 children patients with infectious mononucleosis （study group） and 25 sex- and age-matched health children （control group） without allergy history were enrolled in this study. Informed consent was obtained from all participates. There had no significant difference of age and gender between study group and control group （P〉0.05）. The samples of peripheral blood （2 mL） in study group were collected in acute phase, convalescent phase （at the first month, third month, and sixth month） and the same to control group. All samples were analyzed the expression of CD3 ＋, CD4＋, CD8＋, CD19＋ and CD19＋ CD23＋ on peripheral blood lymphocytes by flow cytometry. Results （1） Compared with control group, the expression of CD4＋[（14.84±5. 03）%] and CD4＋/CD8＋ [（0. 25±0. 13）%],CD19＋ [（3. 89±1. 32）%] and CD19＋ CD23＋ [（0.24±0.13）%] were markedly decreased in the acute stage of study group. One way analysis of variance among five groups had significant difference （P〈0. 001）. The expression of CD3＋ [（82.55 ± 5.49）%] and CD8＋ [（66. 17±8. 10）%] were obviously increased in the acute stage of study group compared with control group （P〈0. 001）. （2）As time went by and the infection was controlled, CD4＋ , CD4＋/CD8＋, CD19＋, and CD19＋ CD23＋ of study group raised increasingly than those of control group, CD3＋ , CD8＋ reduced decreasingly in study group. （3）There were no significant difference on the expression of CD3 ＋ , CD4 ＋ , CD8＋ , CD4 ＋/CD8＋ and CD19 ＋ CD13 ＋ between study group at the sixth month and control group （P〉0.05）, but the expression of CD19＋ of study group at the sixth month was lower than that of control group（P〈0. 001）. Conclusion The expression of CD4＋ , CD4＋/CD8＋, CD19＋ and CD19＋ CD23＋ were markedly decreased in the acute stage. The expression of CD3＋ , CD8 ＋ were obviously increased in the acute stage. The expression of CD3＋ , CD4 ＋ , CD8＋ , CD4 ＋/CD9＋ and CD19＋ CD23 ＋ returned to normal at the sixth month, but the expression of CD19＋ did not return at the sixth month. Children patients with infectious mononucleosis have secondary humoral immunosuppression, which continued for long time after the recovery. This study shows an experimental evidence that treated the disease with immunoglobulin.