前驱疱疹病毒感染对年幼儿ITP细胞免疫功能及疗效的影响

Nalysis of effects of prodromal herpes virus infection on the cell immune system and curative result of young children with ITP

目的 了解前驱疱疹病毒感染对年幼儿ITP发病时细胞免疫功能及一线药物治疗效果的影响.方法 回顾性研究北京儿童医院血液病中心2011年10月-2012年11月收治的首次住院并确诊为ITP的婴幼儿病例.根据有无前驱疱疹病毒感染分为感染组和非感染组,对比分析两组间：（1）细胞免疫功能：病初检测两组患儿淋巴细胞亚群及T辅助细胞因子浓度并进行比较;（2）近期一线治疗效果：2周内一线药物治疗后血小板计数恢复情况.因2～6个月为特殊年龄段,对其组内感染与非感染组进行了统计分析.结果 共收治ITP患儿62例,其中感染组24例,非感染组38例.（1）对细胞免疫功能的影响：①淋巴细胞亚群：感染组与非感染组相比,THL减少（t=-2.187,P＜0.05）,TSL增多（t=3.211,P＜0.05）,CD4/CD8明显降低（t=-2.619,P＜0.05）.②两组间T辅助细胞因子浓度差异无显著性（P＞0.05）,感染组IL-2、IL-4、IL-6、IL-10、TNF、INF-γ中位数均较非感染组减少,仅IL-17较非感染组增多.（2）对近期一线治疗效果影响：共获得缓解52例,其中感染组20例（38％）,非感染组32例（62％）,x2检验结果提示差异无显著性（P＞0.05）.结论 前驱疱疹病毒感染使婴幼儿ITP免疫系统中TSL增多,THL减少,大多数Th细胞辅助因子（除IL-17外）有减少趋势,呈免疫抑制状态;但尚未影响疾病的近期一线治疗效果.

Objective To analyze the effects of prodromal herpes virus infection on the cell immune system and curative result of young children with ITP.Methods We retrospectively collected children with ITP during early onset period in Hematology Center of Beijing Children＇s Hospital between Oct.2011 and Nov.2012.We divided the children into two groups （Infection Group and Non-infection Group） according to whether they have pro-dromal herpes virus infection.Then we analyzed the effect on （1） the cell immune system：To test CD series percentage and TH cell cytokines level of both groups by the Cytometric Bead Array ; （2） curative result of recent first-line treatment in short term：To test the platelet quantities of both groups after short term （about in two weeks） first-line treatment.Results We enrolled 62 cases in all,including infection Group （24 cases） and non-infection Group （38cases）.（1）Effects on the cell immune system：①CD series percentage：Compared with non-infection Group,infection Group has a higher level of TSL（t =3.211,P 〈 0.05） and lower level of THL（t =-2.187,P 〈 0.05）.And the CD4/CD8 rate was obvious decreased （t =-2.619,P 〈 0.05）.②TH cell cytokines level：The differences between the two groups were not significant （P 〉 0.05）.But Infection Group may have a tendency to have a lower level of IL-2,IL-4,IL-6,IL-10,TNF and INF-γ except for IL-17.（2）Effects on curative result of first-line treatment in short term：There were 52 remission cases including infection Group （20 cases,38.46%）and non-infection Group （32 cases,61.54%）.There is no significant differences between the two groups by x2 test.Conclusion Prodromal herpes virus infection can increase the TSL and decrease the THL in young children with ITP.Most TH cell cytokines have a tendency to decreased （except for IL-17）,and the cells are in immunosuppression.But the infection has no effect on the curative result of first-line treatment in short term.