吉兰-巴雷综合征患儿血清白细胞介素-21、白细胞介素-23和白细胞介素14的变化及免疫球蛋白对其的影响

Effects of interleukin-21 ,interleukin-23 and interleukin-4 on the pathogenesis of Guillain-Barr4 syndrome and the influence of intravenous immunoglobulin

目的探讨IL-21、IL-23和IL-4在小儿吉兰-巴雷综合征（GBS）发病机制中的作用和IVIG治疗GBS患儿对IL-21、IL-23和IL4水平的影响。方法将2005年1月至2012年9月山东大学附属省立医院住院的GBS患儿41例根据发病后开始应用IVIG治疗的时间及Hughe8肢体运动功能评分进行分组，根据发病后开始应用[VIG治疗的时间分为2组：A组：发病7d内给予IVIG；B组：发病8～12d给予IVIG，另外根据Hughes肢体运动功能评分分为轻症组、重症组，采用ELISA法检测治疗前后患儿血清IL-21、IL-23和IL．4水平变化。结果A组、B组治疗前患儿血清IL-21、IL-23和IL-4水平无统计学差异；治疗后2组患儿血清IL-21和IL-23水平均较治疗前明显降低（P均〈0．05），IL4水平较治疗前无统计学差异；治疗后A组、B组血清IL-21、IL-23及IL_4水平无统计学差异（P均〉0．05）；治疗前后重症组IL-21、IL-23水平均明显高于轻症组（P均〈0．05），IL4水平2组比较无统计学差异；治疗后轻、重症2组IL-21、IL-23水平均较治疗前明显下降（P均〈0．05），IL4水平治疗前后无统计学差异。结论GBS患儿血清IL-21、IL-23水平明显升高，可能参与GBS发生，静脉注射IVIG后IL-21和IL-23水平明显降低，说明IVIG可通过抑制IL-21、IL-23的分泌减轻细胞炎性反应，阻止GBS的发展，IL-4治疗前后无明显变化，IVIG未明显影响IL4的分泌，IL4可能在GBS恢复中起重要作用。

Objective To investigate the effects of IL-21, IL-23 and IL-4 in the pathogenesis of Guillain-Barr6 syndrome（GBS） of children, and to analyze the influence of intravenous immunoglobulin（IVIG） on the serum levels of IL-21 ,IL-23 and IL-4 in GBS patients. Methods Forty-one pediatric patients with GBS hospitalized in our department from Jan. 2005 to Sep. 2012 were studied. According to the time of IVIG administration,patients were divided into group A and group B, given IVIG respectively within the 7th day and the 8＇h - 12＇h day. According to Hughes score, patients were divided into mild group and severe group. The serum levels of IL-21, IL-23 and IL-4 were detected by means of ELISA before and after treatment. Results Before treatment,the serum levels of IL-21 ,IL-23 and IL-4 had no signifi- ant difference between group A and group B. After treatment,tbe serum levels of IL-21 ,IL-23 in group A and group B were significantly decreased than those before treatment （ all P 〈 0.05 ）, with no significant difference in IL-4 levels. There was no signifiant difference in group A and group B in the serum levels of IL-21, IL-23 and IL-4 after treatment （all P 〉 0.05 ）. In the severe group, the serum levels of IL-21, IL-23 were significantly higher than those in the mild group before and after treatment （all P 〈 0.05 ）, with no significant difference in IL-4 levels. After treatment, the serum levels of IL-21 ,IL-23 were significantly decreased than those before treatment in the mild group and the severe group （ all P 〈 0. 05 ）, with no significant difference in IL-4 levels. Conclusions The serum levels of IL-21, IL-23 are significantly increased in GBS children,indicating they play an important role in the pathogenesis of GBS. Levels of IL-21 and IL-23 are significantly decreased after administration of IVIG, which showed that IVIG could inhibit the secretion of IL- 21 and IL-23 ,reduce cellular inflammatory response,and eventually prevent the development of GBS. IL-4 secretion is not obviously affected with IVIG,it might have a role in the recovery of GBS.