不同病原菌所致社区获得性肺炎患儿急性期免疫功能变化

Changes of immune function in acute phase of community-acquired pneumonia from different pathogens in children

目的探讨不同病原菌所致社区获得性肺炎(CAP)患儿急性期血淋巴细胞亚群及免疫球蛋白的变化及意义。方法 CAP急性期患儿85例分为肺炎链球菌肺炎(SP组,18例)、呼吸道合胞病毒肺炎(RSV组,27例)和肺炎支原体肺炎(MP组,40例)。对照组为40名健康儿童。采用流式细胞术和全自动生化分析仪检查外周血淋巴细胞亚群、免疫球蛋白和补体水平。结果与对照组比较,CAP患儿外周血CD3+、CD4+、CD4+/CD8+比值和自然杀伤细胞水平降低;SP组及MP组降低更明显(P<0.05)。CAP患儿外周血IgA较对照组增高(P<0.05或P<0.01);SP组患儿IgG和IgM较对照组增高(P<0.05),RSV组患儿lgG和IgM较对照组降低(P<0.05或P<0.01),MP组患儿血清IgM、IgE及补体C3、C4水平均较对照组升高(P<0.01)。结论不同病原菌所致CAP患儿急性期均存在明显细胞及体液免疫功能紊乱。

Objective To investigate the changes and clinical significance of immunoglobulin and lymphocyte subsets in acute phase of community-acquired pneumonia （CAP） from different pathogens in children. Methods A total of 85 children with CAP in acute phase was divided into three groups of SP （infected by streptococcus pneumoniae pneumonia, 18 cases）, RSV （infected by respiratory syncytial virus, 27 cases） and MP（infeeted by myeoplasma pneumonia, 40 cases）. Forty healthy children were taken as the controls（group C）. Serum CD3 ＋ , CD4＋ , CD8＋ , CD194 and natural killer（NK） cells expression on the surface of peripheral lymphocytes were analyzed by flow cytometry, and serum levels of IgA, IgG, IgM and complement C3 and C4 were detected by automatic biochemistry analyzer. Results Serum levels of CD3＋ , CD4 ＋ , NK cells and the ratio of CD4＋ /CD8＋ were lower in CAP children, especially those in groups of SP and MP, than those in group C （P〈0. 05）. Serum level of IgA was higher in CAP children than that in group C（P〈0.05 or P（0. 01）. Serum levels of IgG and IgM were higher in group SP than those in group C（P〈0. 05）, which were lower in group RSV than those in group C（P〈0.05 or P〈0. 01）. Serum levels of IgM, IgE and complement C3 and CA were higher in group MP than those in group C（P〈0. 01）. Conclusion The disturbances of cellular and humoral immunity exist in acute phase of CAP from different pathogens in children.