高胆红素血症对新生儿T淋巴细胞亚群、血清可溶性白细胞介素-2受体变化趋势的影响和意义

Dynamic changes and the significance of T-cell subsets and serum soluble interleukin-2 receptor in neonates with hyperbilirubinemia

目的 探讨新生儿高胆红素血症（简称高胆）时T淋巴细胞亚群和血清可溶性白细胞介素-2受体（soluble interleukin-2 receptor,sIL-2R）水平的变化趋势及其临床意义.方法 选择2006年12月1日至2007年1月31日住院的31例高胆新生儿作为高胆组,再根据黄疸程度分为重度黄疸组和轻度黄疸组;将其中16例随访病例按照病程分为黄疸高峰期与黄疸恢复期.选取同期与高胆组日龄相匹配的32例健康足月新生儿（无黄疸或血清胆红素水平≤204.0 μmol/L）作为与高胆组相对应的对照组（对照组Ⅰ）;选取同期与黄疸恢复期病例日龄相匹配的26例健康足月新生儿（日龄＞7 d）作为与随访病例相对应的对照组（对照组Ⅱ）.采用方差分析及两两检验比较各组血清胆红素、T淋巴细胞亚群、sIL-2R水平,并分析其间的相关性.结果 高胆组新生儿的CD3、CD4、CD4/CD8比值分别为（54.0±5.1）%、（26.8±5.0）%和0.8±0.1,较对照组Ⅰ[（62.0±4.7）%、（43.0±4.7）%和1.4±0.2]降低（P＜0.01）;而黄疸恢复期较黄疸高峰期增高[（62.4±3.3）%和（55.1±4.2）%、（43.6±2.5）%和（26.1±4.4）%、1.4±0.1和0.8±0.1]（P＜0.01）;黄疸高峰期血清sIL-2R水平[（319.4±185.2）kU/L]高于黄疸恢复期[（129.7±99.3）kU/L]和对照组Ⅱ[（171.9±102.2）kU/L]（P＜0.01）.总体的血清胆红素水平与CD4/CD8比值呈负相关（r=-0.99,P＜0.01）,与sIL-2R水平呈正相关（r=0.95,P＜0.05）,sIL-2R水平与CD4/CD8比值呈负相关（r=-0.92,P＜0.05）.结论 新生儿高胆时存在细胞免疫功能抑制状态,该抑制状态有随着黄疸消退而逐渐减轻的趋势.

Objective To investigate the dynamic changes and the clinical significance of T-cell subsets and serum soluble interleukin-2 receptor （sIL-2R）in neonates with hyperbilirubinemia.Methods Thirty-one neonates with hyperbilirubinemia, admitted to the hospital from Decembr 1,2006 to January 31, 2007, were enrolled and divided into two subgroups： severe jaundice group and mild jaundice group according to the bilirubin level. Thirty-two age-mached healty newborns were as controls（control group Ⅰ）. The T-cell subsets and sIL-2R of peripheral venous blood samples from these neonates were measured and compared. Sixteen of these 31 neonates with hyperbilirubinemiawere followed up and another twenty-six age-mached healty newborns were as controls（control group Ⅱ ）. The level of serum bilirubin in convalescence of sixteen hyperbilirubinemia neonates and control group Ⅱ were tested and analyzed also. Results The levels of CD3, CD4, CD4/CD8 in the neonates with hyperbilirubinemia were lower compared with those of control group Ⅰ [（54.0±5.1）% vs （62.0±4.7）%, （26.8±5.0）% vs （43.0±4.7）%, 0.8±0.1 vs 1.4±0.2] （P〈0.01）, but was higher in convalescence than in peak phase[ （62.4±3.3）% vs （55.1±4.2）%, （43.6±2.5）% vs （26.1±4.4）%, 1.4 ± 0.1 vs 0.8±0.1] （P〈0.01）. The peak level of sIL-2R in the hyperbilirubinemia group was （319.4± 185.2） kU/L, higher than that in the convalescence [（129.7±99.3） kU/L] and in the control group Ⅱ [（171.9±102.2） kU/L] （P〈0.01）. The serum bilirubin level showed negative correlation with CD4/CD8 （ r = -0.99, P 〈 0.01 ） and positive correlation with sIL-2R （r=0.95, P〈0.05）. The sIL-2R level was negatively correlated with CD4/CD8 （r=-0.92, P〈0.05）. Conclusions Neonates, when suffering from hyperbilirubinemia, are immunosuppressed which may recover with the alleviation of jaundice.