麻疹患儿细胞免疫及临床分析

Cellular Immunity of Children with Measles and Clinical Analysis

目的探讨小儿麻疹的临床特征和外周血淋巴细胞亚群的变化。方法收集2008年3月～2010年7月杭州市六医院的住院麻疹患儿794例作为病例组，分析其临床资料分布特征，同时采集285例麻疹患儿外周血，用荧光标记的抗体染色，流式细胞术分析麻疹患儿外周血淋巴细胞亚群的变化。结果794例麻疹患儿以农村及流动人口为主（占83．9％），临床均有发热、咳嗽和特征性皮疹，热峰均高于39．0℃（肛温），大部分患儿可见柯氏斑（占68．4％），19．5％并发支气管肺炎。麻疹患儿外周血淋巴细胞亚群中CD8＋T淋巴细胞和NK细胞百分率明显高于正常组（P〈0．05），而CD3＋T淋巴细胞百分率、CD4＋T淋巴细胞百分率和CD4／CD8比值没有统计学差异（P〉0．05）。结论麻疹流行原因与患儿未按时接种疫苗、复种不及时及人员流动性较强有关。柯氏斑诊断特异性仍较高。并发症以支气管肺炎最常见。麻疹患儿的细胞免疫中以CD8细胞和NK细胞增加为丰．

Objective To investigate the clinical characteristics and peripheral - blood lymphocyte subpopulatious of children with measles. Methods The clinical data of 794 cases were collected and analyzed in Hangzhon Sixth Hospital from May 2008 to July 2010. Peripheral - blood samples of 285 cases were collected and dyed with fluorescence - labelled antibody. The change in peripheral - blood lymphocyte subpopulations of children with measles was analyzed with flow cytometry. Results There were mostly rural population or floating population in 794 cases,accounting for 83.9% . All the children had a fever and cough and marked rash. The hot bands were all above 39.0℃ （rectal temperature）. Most had Koplik spot, accounting for 68.4% , among whom 19.5% were complicated with bronchopneumonia. Compared with the normal group, the percentage of CD8 and NK ceils in peripheral - blood lymphocyte subpopulations of children with measles was significantly increased （P 〈 0.05 ）. The percentage of CD3, CD4 and CD4/CD8 had no significant difference between measles children and centrols（ P 〉 0.05）. Conclusion The reasons of the prevalence maybe related to two parts below. One was that some children had no inoculation and revaccination,and the other was the fluidity of the personnel. Koplik spot had high specificity. The complications were mostly bronehopneumonia. In acute period,CD8 and NK cell increased in the cellular immunity.