小儿轮状病毒肠炎肠道外脏器损伤及免疫状态研究

Parenteral organ injury and immune status in children with rotavirus enteritis

目的 研究轮状病毒肠炎并发肠道外损伤的发生情况及影响因素,监测轮状病毒肠炎患儿免疫球蛋白和淋巴细胞亚群变化,了解轮状病毒肠炎患儿发病时免疫状态.方法 研究对象为2007年1月至2008年12月在我院住院确诊的轮状病毒肠炎患儿（观察组）64例,对照组为同期在发育儿科体检正常者18例.记录患儿临床表现的同时,采用ELISA方法检测粪便轮状病毒特异性抗原,流式细胞术进行淋巴细胞亚群分析,透色比浊法测定血清IgG、IgA、IgM,生化法检测肝功能和心肌酶谱.结果轮状病毒感染可导致肝脏、心肌、呼吸及神经系统等多脏器损害.观察组患儿丙氨酸氨基转移酶（ALT）、天冬氨酸转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-mB）活性均明显高于对照组（P〈0.05）;〈1岁组患儿肝功能损伤发生率显著高于〉1岁组（P〈0.05）;重型腹泻组患儿CK[（324.5±995.5）U/dl]、CK-mB[（93.8±61.5）U/dl]活性明显高于轻型者[CK（252.8±130.4）U/dl,CK-mB（59.6＋32.6）U/dl],差异有显著性（P〈0.05）.观察组免疫球蛋白IgG[（4.46±1.56）g/L]明显低于对照组[（5.80±1.67）g/L],差异有显著性（P〈0.05）;淋巴细胞亚群中观察组CD4＋[（29.0±4.18）%]较对照组[（38.6±3.97）%]降低,CDl9＋检测结果[（38.8±3.94）%]较对照组[（23.1±7.70）%]升高,差异均有显著性（P〈0.05）;观察组患儿CD4＋/CD8＋比例倒置.结论 轮状病毒肠炎患儿可出现肠道外感染表现,以呼吸系统、肝脏、心肌及中枢神经系统受累居多;轮状病毒感染可导致体液及细胞免疫功能低下.肝功能、心肌酶谱、免疫球蛋白及淋巴细胞亚群测定对监测患儿病情变化及指导治疗有重要的临床意义.

Objective To evaluate the parenteral complications and their risk factors and to study the immune status by detecting immunoglobulin and lymphocyte subsets in children with rotavirus enteritis. Methods Sixty-four children with rotavirus enteritis who were treated in Shengjing Hospital of China Medical University between January 2007 and December 2008 （observation group） and 18 healthy children for health screening at pediatric health care center （ normal control group） were recruited. Clinical manifestations were collected, stool specimens were detected for rotavirus using ELISA,lymphocyte subsets were detected u- sing flow cytometer, and immunoglobulin,liver enzyme and myocardial enzyme were detected. Results Ro- tavirus enteritis may be complicated by parenteral complications （liver, myocardium, respiratory and nervous system）. The activity of ALT,AST,LDH,CK and CK-mB were higher in observation group than that in normal control group （ P 〈 0.05 ）. In observation group, liver injury rate in children younger than 12 months was higher than that in children older than 12 months,and the activity of CK and CK-mB were higher in severe diarrhea cases [ CK （ 324. 5 ± 995.5 ） U/dl, CK-mB （93.8 ± 61.5 ） U/dl ] than that in mild diarrhea cases [CK （252. 8 ± 130.4） U/dl,CK-mB（59. 6 ±32.6） U/dl] （P 〈0.05）. The level of IgG was lower in observation group [ （4.46 ± 1.56） g/L ] than that in control group [ （ 5.80 ± 1.67 ） g/L ] （ P 〈 0. 05 ）. Lymphocytes subsets study revealed that the activity of CD4 ^＋ in observation group [ （29.0 ± 4. 18）% ] was lower than that in control group[ （ 38. 6 ± 3.97 ） % ] （ P 〈 0. 05 ）, the activity of CD19 ^＋ [ （ 38.8 ± 3.94 ） % ] was higher than that in control group [ （23.1 ± 7. 70） % ] （ P 〈 0. 05 ） and the CD4 ^＋/CD8 ^＋ ratio was reverse in observation group. Conclusion Rotavirus enteritis may be complicated by parenteral injuries which get liver, myocardium, respiratory and nervous system involved. Children with rotavirus enteritis can lead to low immune function. Determination of fiver enzyme, myocardial enzyme, immunoglobulin and lymphocyte subsets has important clinical significance to monitoring the change of condition and guiding treatment.