小儿病毒性脑炎外周血T淋巴细胞亚群和脑脊液免疫球蛋白水平的动态观察

Dynamic Observation of Peripheral Blood T Lymphocyte Subsets and CSF Immunoglobulin Levels among Children with Viral Encephalitis

目的:探讨病毒性脑炎患儿免疫学指标水平的动态变化以指导临床。方法:对20例病脑患儿分别于急性期(病后1～2天)、临床治愈后(约2周)、治疗后4周抽取外周血测T淋巴细胞亚群百分率并腰椎穿刺查脑脊液免疫球蛋白含量进行检测。同时抽取20例健康查体儿童外周血测T淋巴细胞亚群百分率作为对照。脑脊液各项免疫指标于治疗前后行自身对照。结果:急性期病脑患儿外周血CD_3^+及CD_4^+百分率较对照组明显降低,CD_8^+百分率高于对照组,差异有显著性,脑脊液免疫球蛋白含量以IgA为主均有降低,但与正常值比较无显著性差异;动态观察2周后,显著性差异仍存在;4周后各项指标恢复正常。结论:病毒性脑炎的发病以细胞免疫异常为主,同时可伴有体液免疫功能的异常。并且由病脑引起的免疫指标的完全恢复在临床治愈之后。

Oblective：To explore the dynamic changes of the immunology indexes among children with viral encephalitis to give the instruction to the clinic treatmant.Methods：Peripheral blood samples were taken from 20 cases of children with viral encephalitis respectively from the acute stage（1-2 days after the infection）,restoration stage（about 2 weeks）,and four weeks after the treatment to measure the percentage of T-lymphocyte subsets and at the same time the percentage of the cerebrospinal fluid（CSF） immunoglobulin is measured by the means of lumbar puncture. Meanwhile,the percentage of t-lymphocyte subsets was obtained by taking the peripheral blood samples from the control group of 20 healthy children.Results：The percentage of peripheral blood CD3 and CD4 of the children with viral encephalitis in the acute stage was significantly lower than the control group while the percentage of peripheral blood CD8 is much higher.These differences are quite striking. But the percentage of CSF immunoglobulin, mainly the percentage of IGA, is lower on average,but there were no significant differences from the normal level.After observing for 2 weeks,the significant differences in the percentage of peripheral blood CD3,CD4,and CD5 still exist. Four weeks after the treatment, all the above-mentioned indexes are restored to normal level.Conclusion：Viral encephalitis among children is mainly associated with the dysfunction of cell immunity, and is sometimes accompanied by the dysfunction of humeral immunity.All the immunity indexes caused by viral encephalitis will be totally recovered after the clinic treatment.