手足口病患者急性期体液免疫功能分析

Analysis on function of the humoral immunity in patients with hand ,foot and mouth disease in acute stage

目的 探讨手足口病患儿急性期体液免疫功能状态与发病、病情严重程度的关系.方法 对2010年4月至2011年3月杭州市儿童医院收住的668例手足口病患儿资料进行回顾性分析,根据病情分为重症组（伴脑炎组）140例和轻症组（无脑炎组）528例,以同期的其他疾病儿童140例为对照组；以免疫比浊法测定血清总球蛋白,免疫球蛋白IgG、IgM、IgA及补体C3、C4水平,并进行各年龄组间、不同病情严重程度组间的比较.结果 手足口病重症组患儿的总球蛋白、IgG、IgA、IgM、C3、C4水平的中位数分别为24.95、7.91、0.50、1.51、1.19和0.41 g/L,与轻症组与对照组三组间的差异有统计学意义（x2=28.213,18.884,6.954,26.157,47.117,14.136；P均＜0.05）.其中重症组各项指标高于轻症组,差异有统计学意义（Z=-3.481,-3.627,-2.670,-3.915,-2.800,-3.048;P均＜0.05）.2岁以下重症组IgG水平为（7.80±4.21）g/L,高于轻症组,差异有统计学意义（t=-2.196,P＜0.05）;2岁至6岁重症组的总球蛋白、IgG、IgM、C3及C4水平分别为（27.75±4.91）、（9.69±3.57）、（1.84±0.63）、（1.24±0.18）和（0.43±0.09） g/L,均高于轻症组,差异有统计学意义（t=-3.626,-2.897,-3.674,-2.337,-3.098;P均＜0.05）.结论 手足口病重症患儿（尤其2岁以上）急性期的总球蛋白、IgG、IgM、C3、C4水平明显增高,存在免疫功能亢进,体液免疫水平与病情轻重相关.

Objective To investigate the humoral immune function status of children with hand,foot and mouth disease（HFMD） in acute stage,and discuss the relation between the onset and severity of illness.Methods The data of 668 children who were diagnosed as HFMD in Hangzhou Children＇s Hospital from April 2010 to March 2011 were recruited in the study.According to the severity of illness,the patients were divided into 2 groups：the severe case group （with encephalitis,n=140） and the mild case group （without encephalitis,n=528）,and 140 cases of children with other diseases as controls in the same period.The comparisons between groups of ages and groups of severity disease into the levels of serum globulin,IgG,IgM,IgA,C3 and C4,which were measured by immunoturbidimetric assay were studied.Results The median levels of globulin,IgG,IgA,IgM,C3 and C4 in severe case group were 24.95,7.91,0.50,1.51,1.19 and 0.41 g/L,and there were significant differences observed among 3 groups （x2=28.213,18.884,6.954,26.157,47.117 and 14.136;P all〈0.05）.Compared with the mild group,all the observed values in severe case group were higher（Z=-3.481,-3.627,-2.670,-3.915,-2.800,-3.048;P all〈0.05）.In the children who were under 2 years old,the level ofIgG in the severe case group was（7.80±4.21） g/L,and was higher than the mild case group （t=-2.196,P〈0.05）.While in the children who were 2-6 years old,the levels of serum globulin,IgG,IgM,C3 and C4 in the severe case group were （27.75±4.91）,（9.69 ±3.57）,（1.84±0.63）,（1.24±0.18）,（0.43±0.09）g/L respectively,and all higher than the mild case group （t =-3.626,-2.897,-3.674,-2.337,-3.098 ;P all〈0.05）.Conclusions The severe HFMD cases especially who are more than 2 years old have the hyperimmunefunction with the higher levels of globulin,IgG,IgM,C3 and C4.The humoral immune level is associated with disease severity.