重症手足口病患儿免疫功能的动态变化及意义

Dynamic variation and significance of immune function of children with severe hand foot and mouth disease

目的 观察和分析手足口病从普通病例发展到重症病例过程中免疫功能的动态变化.方法 测定20例手足口病患儿普通病例时期和发展到重症病例后,其免疫球蛋白（IgG、IgA、IgM）及T淋巴细胞亚群（CD3、CD4、CD8、CD4/CD8）的水平;以同期20例健康儿童为对照组,比较免疫功能的动态变化.结果 与对照组比较,手足口病普通病例组IgG（8.322±1.487）g/L、IgA（0.584±0.172）g/L、IgM（1.345±0.367）g/L均有显著降低,CD4/CD8（1.18±0.28）亦显著降低,CD8（29.30±4.08）则显著升高,差异均有显著性（P＜0.05）,而CD3、CD4无显著变化;手足口病重症病例组与普通组比较,则IgA（0.321±0.018）g/L、CD3（50.26±5.32）、CD4（30.25±2.71）、CD4,CD8（0.87±0.15）均显著下降,而CD8（37.42±4.2）显著升高（P＜0.05）,而IgG、IgM无显著变化.结论 手足口病普通病例免疫功能变化主要是体液免疫下降,细胞免疫的改变不大,而发展到重症病例,则主要表现为CD3、CD4、CD4/CD8下降,CD8升高等细胞免疫改变;提示细胞免疫的紊乱是导致重症手足口病发生的重要因素之一,在轻、重症的鉴别中有一定的临床意义.

Objective To observe and analyze the dynamic variations of immune function of children with hand foot and mouth disease （HFMD） from ordinary to severe. Methods The level of immune globulin （IgG, IgA, IgM）and T lymphocyte subgroup（CD3, CD4, CD4/CD8） of 20 children patients with HFMD from normal to severe were determined, and 20 healthy children were used as control, and their dynamic variation of the immune function were compared. Results The IgG, IgA and IgM of normal group of the children patients with HFMD were significantly lower than those of the control group （P〈0.05）, and the CD4/CD8 was also decreased significantly, but the CD8 was significantly increased （P〈0.05）, and the CD3, CD4 did not vary significantly. Compared to the severe group, the IgA, CD3, CD4, CD4/CDg of HFMD normal group were significantly decreased, but the CD8 was significantly increased （P〈0.05）, and the IgG, IgM did not change significantly. Conclusion The immune function of children patients with normal HFMD mainly declined in humoral immunity and the cellular immunity didn t change significantly. And if the HFMD became severe, the main signs were the cellular immunity changes such as the decrease of the CD3, CD4, CD4/CD8, and the increase of the CD8 It suggested that the disorder of the cellular immunity was one of the main factors leading to the severe HFMD, which has some clinical meaning in identification of the normal and severe cases.