手足口病患儿血清细胞因子检测及意义

The changes of cytokines in children with hand-foot-mouth disease

目的探讨不同严重程度手足口病患儿外周血细胞因子的变化特点。方法2011年3月至12月住院的62例手足口病患儿为研究对象，其中男37例，女25例；年龄最小4个月，最大4岁11个月，平均年龄（1．56±0．89）岁。按照病情分组：普通组20例，重症组20例，危重症组22例。对照组为22例健康儿童。检测各组血清促炎细胞因子[肿瘤坏死因子（tumornecrosisfactor，TNF）-α、白细胞介素（interleukin，IL）-1β、IL-6]和抗炎细胞因子（IL-10、IL-13、IL-4）的水平。结果与对照组比较，手足口病各组患儿外周中促炎及抗炎细胞因子均升高。重症组及危重症组促炎细胞因子TNF-α水平分别为（201．45±133．42）ng／L、（220．37±117．54）ng／L，均比普通组（118．12±112．05）ng／L明显升高（P〈0．05），IL-1β及1L-6水平在危重症组分别为（651．77±538．45）ng／L、（88．02±50．76）ng／L，均较重症组[（551．75±252．75）ng／L、（59．25±28．80）ng／L]及普通组[（270．18±249．79）ng／L、（55.76±28．68）ng／L]明显升高（P〈0．05）。抗炎细胞因子IL-10水平在普通组升高最明显，为（137．53±72．07）ng／L，而重症及危重症组仅轻度升高，分别为（57．07±55．02）ng／L及（73．37±56．01）ng／L（P〈0．05）。IL-13水平重症组为（507．53±210．86）ng／L，危重症组为（489．67±168．99）ng／L，均比普通组（387．16±157．43）ng／L明显升高（P〈0．05），IL4水平在手足口病各组中差异无统计学意义（P〉0．05）。结论手足口病患儿存在促炎因子与抗炎因子同时参与的炎症反应，其中促炎细胞因子TNF-α、IL-1β及IL-6升高与病情的严重程度相一致，而抗炎细胞因子IL-10、IL-13随病情的加重反而降低，因此促炎因子的升高、抗炎因子的下降是疾病恶化的重要标志。

Objective To study the changes of cytokines in children with hand-foot and mouth dis- ease. Methods Sixty-two cases of hand-foot-mouth disease admitted to our hospital from March 2011 to De- cember 2011 were included in this study. Thirty-seven cases were male and 25 cases were female, the youn- gest one was four month old, and the oldest one was eleven month and 4 years old, the average age was （ 1.56 ± 0. 98） years old. Sixty-two children with hand-foot-mouth disease were devided into ordinary group （ n = 20）, severe group （ n = 20 ）, critically ill group （ n = 22 ）. Twenty healthy children served as control group. The plasma levels of pro-inflammatory cytokines [ tumor necrosis factor （TNF） -α, interleukin （ IL ） - 1β, IL-6] and anti-inflammatory cytokines（IL-10、 IL-13、IL-4） were detected. Results The pro-inflammatory and anti-inflammatory cytokines of patients with hand-foot and mouth disease were increased compared with control group. The levels of TNF-α in severe and critically ill groups were （201.45± 133.42 ） ng/L, （220. 37 ± 117.54）ng/L respectively, which significantly increased compared with ordinary group [ （118. 12 ±112.05） ng/L] （P 〈0. 05）. The levels of IL-1β and IL-6 in critically ill cases were （651.77 ±538.45） ng/L and （88.02 ±50. 76） ng/L respectively,which significantly increased compared with severe cases [ （551.75 ± 252. 75） ng/L, （59. 25 ±28. 80） ng/L] and ordinary cases [ （270. 18 ±249. 79） ng/L,（55.76±28. 68） ng/L]（P 〈 0. 05）. The level of IL-10 was （ 137. 53 ±72. 07） ng/L in ordinary cases,which increased significantly compared with the severe and critically ill cases [（ 57. 07 ± 55.02） ng/L, （73. 37 ± 56. 01 ） ng/L ] （ P 〈 0. 05 ）. The levels of IL-13 were （507. 53 ±210. 86） ng/L and （489. 67 ±168. 99） ng/L in severe and critically ill cases respectively, which significantly increased compared with ordinary cases [ （387. 16 ± 157.43） ng/L] （P 〈0. 05）. The levels of IL-4 showed no significant differences among the ordinary, severe and critically ill groups （P 〉 0. 05）. Conclusion The pro-and anti-inflammatory cytokines were involved in inflammatory response simultaneously in patients with hand-foot and mouth disease. The increases of TNF-α,IL-1β and 1L-6 are consistent with severity of the dis- ease,while factor IL-10,IL-13 are decreased as the severity of the disease. The increase of the pro-inflammatory cytokines and decrease of the anti-inflammatory cytokines are the important sign of the exacerbation.