小儿病毒性心肌炎与Fas／Fas1介导的外周血淋巴细胞凋亡的关系

Role of Fas/Fas figand apoptotic pathway of peripheral blood lymphocytes in the development of viral myocarditis

目的探讨Fas／Fas1介导的外周血淋巴细胞凋亡在病毒性心肌炎发病中的作用。方法选择临床诊断病毒性心肌炎患儿和正常小儿各25例，采用Annexin V／PI双参数法经流式细胞仪定量检测两组小儿外周血淋巴细胞凋亡百分率，并用双色流式细胞仪检测外周血淋巴细胞Fas、Fas1蛋白表达。结果心肌炎患儿外周血淋巴细胞凋亡率[（0．6976±0．1109）％]较正常对照组[（0．1288±0．1069）％]明显升高（t=18．459，P〈0．001），且与肌酸激酶同工酶、乳酸脱氢酶、肌酸激酶、羟丁酸脱氢酶升高程度均呈正相关（r=0．817，P〈0．01；r=0．785，P〈0．01；r=0．726，P〈0．01；r=0．712，P〈0．01）；心肌炎患儿外周血淋巴细胞Fas、Fas1蛋白表达[（2．8804±0．302O）、（4．4496±0．4836）]较对照组[（2．1300±0．6200）、（0．1238±0．0384）]明显增加（t=17．321，P〈0．001；t’=44．577，P〈0．001）；心肌炎患JLgb周血淋巴细胞凋亡百分率与Fas、Fas1蛋白表达均呈正相关（r：0．972，P〈0．01；r=0．958，P〈0．01）。结论病毒性心肌炎患儿外周血淋巴细胞凋亡增加，可能为细胞免疫功能下降的原因之一，且与心肌损害程度相关。Fas、Fas1基因在病毒性心肌炎患儿外周血淋巴细胞凋亡中起着重要作用。

Objective To investigate the role of peripheral blood lymphocyte apoptosis through Fas/ Fas ligand pathway in the development of viral myocarditis. Methods Twenty-five viral myocarditis （VMC） and 25 healthy children were chosen for study. The apoptosis percentage in peripheral blood lymphocytes was quantitatively examined,flow cytometry with Annexin V/PI double parameter was used. And the expressions of Fas and Fasl protein in peripheral blood lymphocytes were analyzed with flow cytometry. Results The percentage of apoptosis in peripheral blood lymphocytes in children with VMC [ （0. 697 6 ± 0. 110 9 ） % ] was significantly higher than that of healthy children [ （ 0. 128 8 ± 0. 106 9 ） % ] （ t = 18. 459, P 〈 0. 001 ）. Moreover, the apoptosis cell percentage showed a significant positive correlation with the serum levels of myocardium enzyme （ creatine kinase-MB, lactate dehydrogenase, creatine kinase, hydroxybutyrate dehydrogenase ） （ r =0. 817 ,P 〈0. 01 ;r =0. 785 ,P 〈0. 01 ;r = 0. 726 ,P 〈0.01 ;r = 0. 712 ,P 〈 0. 01 ）. The expression of Fas and Fasl protein in VMC patients （ 2. 880 4 ± 0. 302 0,4. 449 6 ± 0. 483 6） were higher than those of health children （ 2. 130 0 ±0. 620 0,0. 123 8 ± 0. 038 4 ）, which had significant difference （ t = 17.321, P 〈 0. 001 ; t＇ = 44. 577, P 〈 0. 001 ）. The apoptosis percentage of peripheral blood lymphocytes in children with VMC showed a significant positive correlation with the Fas and Fasl protein expression in peripheral blood lymphocytes（ r = 0. 972, P 〈 0. 01 ; r = 0. 958, P 〈 0. 01 ）. Conclusion Apoptosis percentage of peripheral blood lymphocytes increases among children with VMC, probably because immune response decreased or it is related with the degree of myocardium damaged. Fas and Fasl play an important role in apoptosis of peripheral blood lymphocytes in children with VMC.