重症肺炎支原体肺炎患儿肺泡灌洗液中Th1/Th2细胞免疫应答状况的研究

Th1/Th2 immune response in bronchoalveolar lavage fluid in children with severe Mycoplasma pneumoniae pneumonia

目的检测重症肺炎支原体肺炎(MPP)患儿肺泡灌洗液(BALF)和血清中干扰素-γ(IFN-γ)、白细胞介素-4(IL-4),研究Th1/Th2细胞免疫应答的状况及意义,并评价BALF中细胞因子检测在MPP诊治中的临床价值。方法采用双抗体夹心ELISA检测25例重症MPP患儿BALF和血清中IL-4及IFN-γ的浓度,并设支气管异物组(25例)和MPP轻症组(25例)作为对照。结果重症MPP患儿BALF中IL-4和IFN-γ水平及IL-4/IFN-γ比值明显高于支气管异物对照组,差异有统计学意义(P<0.01或0.05)。重症MPP患儿血清中IL-4水平及IL-4/IFN-γ比值明显高于支气管异物组和MPP轻症组,差异有统计学意义(P<0.01或0.05)。重症MPP患儿BALF中IL-4水平及IL-4/IFN-γ比值高于血清标本,差异有统计学意义(P<0.05)。结论重症MPP患儿存在Th1/Th2失衡,以Th2反应占优势;BALF中细胞因子的检测较之血清更为敏感,在MPP诊治中具有较高价值。

Objective To study the status of Th1/Th2 immune response and the value of the detection of cytokines in bronchoalveolar lavage fluids（BALF） by examining the levels of IFN-γ and IL-4 in BALF and serum in children with severe Mycoplasma pneumonia（MPP）. Methods The levels of IFN-γ and IL-4 in BALF and serum were measured using ELISA in 25 children with severe MPP,25 children with mild MPP and 25 children with foreign body in bronchus. Results The levels of IL-4 and IFN-γ and the IL-4/IFN-γ ratio in BALF in children with severe MPP were significantly higher than those in children with foreign body in bronchus（P〈0.01 or 0.05）.The serum levels of IL-4 and the IL-4/IFN-γ ratio in children with severe MPP were significantly higher than those in children with foreign body in bronchus（P〈0.01） or with mild MPP（P〈0.05）.The levels of IL-4 and the IL-4/IFN-γ ratio in BALF were significantly higher than in serum（P〈0.05）. Conclusions The data suggest that the imbalance of Th1/Th2 exists in children with severe MPP and it seems to represent a predominant Th2-like cytokine response.The detection of cytokines in BALF appears to be more sensitive than in serum and may be of value in the diagnosis and therapy of MPP.