难治性肺炎支原体肺炎患儿支气管肺泡灌洗液中IL-4及INF-γ水平的研究

Levels of interleukin-4 and interferon-gamma in the bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia

目的检测难治性肺炎支原体肺炎(RMPP)患儿支气管肺泡灌洗液(BALF)中IL-4、INF-γ水平,探讨RMPP患儿病变局部Th1、Th2型细胞因子水平的变化及其意义。方法选择RMPP患儿(42例)为研究对象。根据是否有湿疹、过敏性鼻炎、荨麻疹及相关过敏性疾病家族史等将42例RMPP患儿分为特应性组(11例)和非特应性组(31例)。以同期因支气管异物住院、异物取出4周后纤维支气管镜复查的患儿为对照组(12例)。对RMPP患儿及对照患儿BALF中细胞学成分进行分析,并采用ELISA方法检测BALF中IL-4、INF-γ水平。结果与对照组比较,RMPP组患儿BALF中细胞总数上升(P<0.05),其中以中性粒细胞上升为主(P<0.01);RMPP组患儿BALF中INF-γ、IL-4均显著升高(P<0.05)。与对照组比较,特应性组BALF中INF-γ、IL-4均显著升高(P<0.05),非特应性组INF-γ显著升高(P<0.05)。各组间INF-γ/IL-4比值差异均无统计学意义(P>0.05)。结论 RMPP患儿BALF细胞数显著增加,尤以中性粒细胞为甚。RMPP患儿BALF中INF-γ、IL-4水平明显升高,但INF-γ/IL-4比值无变化,提示RMPP患儿病变局部炎症反应明显,但尚不能证实RMPP患儿存在Th2占主导的炎症反应。

Objective To measure levels of interleukin-4 （IL-4） and interferon-gamma （INF-γ） in the bronchoalveolar lavage fluid （BALF） of children with refractory Mycoplasma pneumoniae pneumonia （ RMPP）, and to investigate changes in local Thl-Th2-type cytokine levels in children with RMPP and their significance. Methods A total of 42 children with RMPP were divided into atopic （ n = 11 ） and non-atopic groups （ n = 31 ） according to whether they had eczema, allergic rhinitis, urticaria, and family history of allergic disease. The study also included a control group of 12 children with bronchial foreign bodies who underwent foreign body removal and were re-examined by fiberoptic bronchoscopy four weeks later. The different cells in BALF from all children were analyzed, and the levels of IL-4 and INF- ＂,/in BALF were measured using enzyme-linked immunosorbent assay. Results Compared with the control group, the total number of cells in BALF from children with RMPP increased significantly （P 〈 0.05）, the increase mainly accounted for by neutrophils （P 〈 0. 01 ）, and levels of IL-4 and INF-γ in BALF from children with RMPP increased significantly （ P 〈 0.05 ）. Compared with the control group, levels of IL-4 and INF--γin BALF in the atopic group increased significantly （P 〈 0.05）. The level of INF-3, in BALF in the non-atopic group also increased significantly （P 〈 0.05）. There were no significant differences in INF-γ/IL-4 ratio among all groups （ P 〉 0. 05 ）. Conclusions Significant increase in cell numbers, especially neutrophils, as well as IL4 and INF-γ levels, can be seen in BALF from children with RMPP, but there is no change to the INF-γ/IL-4 ratio. This indicates a significant local inflammatory response in children with RMPP, but there is no evidence of Th2-dominated inflammatory response.