婴幼儿重症肺炎免疫球蛋白、T淋巴细胞亚群的变化及临床意义

Changes and clinical significance of immunoglobulin and T lymphocyte subsets in children with severe pneumonia

目的探讨婴幼儿重症肺炎免疫球蛋白、T淋巴细胞亚群的变化及临床意义。方法收集粤北人民医院儿科2016年6月至2018年6月收治的52例重症肺炎婴幼儿,依据小儿危重病例评分(PCIS)分组,≤70分为极危重组(n=22),70～80分为危重组(n=30),选取20例健康儿童作为对照组,比较两组重症肺炎患儿治疗前及恢复期的血清免疫球蛋白(IgG、IgM、IgA)及T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)水平,并与对照组进行比较。结果外周血IgG、IgM、IgA在对照组[(10.34±1.32) g/L、(1.44±0.15) g/L、(1.99±0.67) g/L]、危重组[(7.74±0.82) g/L、(0.75±0.24) g/L、(0.85±0.07) g/L]、极危重组[(6.38±0.75) g/L、(0.49±0.06) g/L、(0.78±0.08) g/L]间依次降低,三组比较差异均有统计学意义(P<0.05);外周血CD3^+、CD4^+,CD4^+/CD8^+在对照组[(61.86±11.95)%、(38.60±1.51)%、(1.71±0.06)%]、危重组[(55.86±2.63)%、(30.58±3.22)%、(1.21±0.07)%]、极危重组[(51.28±9.13)%,(25.39±3.69)%、(0.88±0.09)%]间依次降低,三组比较差异均有统计学意义(P<0.05);外周血CD8^+在对照组、危重组、极危重组分别为(22.67±2.87)%、(29.97±1.77)%、(33.26±3.90)%,依次升高,三组比较差异有统计学意义(P<0.05);危重组和极危重组恢复期外周血IgG、IgM、IgA、CD3^+、CD4^+、CD4^+/CD8^+均明显高于急性期,CD8^+均明显低于急性期,两组比较,差异均有统计学意义(P<0.05)。结论婴幼儿重症肺炎存在体液和细胞免疫功能紊乱,病情越重免疫功能越低下,因此免疫球蛋白及T淋巴细胞亚群的变化可有效判断肺炎患儿的病情、疗效及预后。

Objective To investigate the changes and clinical significance of immunoglobulin and T lympho- cyte subsets in children with severe pneumonia.Methods A total of 22children with severe pneumonia and 30children with mild pneumonia treated in Department of Pediatrics,Yuebei People's Hospital during June 2016to June 2018 were selected and divided into critical group (n=30)and extremely critical group (n=22)according to the pediatric critical illness score (PCIS).At the same time,20healthy children were selected and included into the control group.The level of serum immunoglobulin (IgG,IgM,IgA)and T drenching in different groups were compared.The level of (CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)was measured.The test was carried out again in the recovery period of severe pneumonia.Results The peripheral blood IgG,IgM,IgA were (10.34±1.32)g/L,(1.44±0.15)g/L,(1.99±0.67)g/L in the control group,(7.74±0.82)g/L,(0.75±0.24)g/L,(0.85±0.07)g/L in the critical group and (6.38±0.75)g/L,(0.49±0.06)g/L, (0.78±0.08)g/L in extremely critical group,which were decreased successively in the three groups,with statistically significant differences (P<0.05).The peripheral blood CD3^+,CD4^+,CD4^+/CD8^+ were (61.86±11.95)%,(38.60±11.51)%, (1.71±0.06)% in the control group,(55.86±7.63)%,(30.58±3.22)%,(1.21±0.07)% in the critical group,and (51.28± 9.13)%,(25.39±3.69)%,(0.88±0.09)% in the extremely critical group,which decreased successively in the three groups, with statistically significant differences (P<0.05).The peripheral blood CD8^+ was (22.67+2.87)%in the control group, (29.97±1.77)% in the critical group and (33.26+3.90)% in the extremely critical group,which was increased successively in the three groups,with statistically significant difference (P<0.05).The peripheral blood IgG,IgM,IgA,CD3^+,CD4^+ and CD4^+/CD8^+ in the convalescence phase were significantly higher than those in the acute stage,and the CD8^+ were significantly lower (P<0.05):Conclusion There is a disorder of cellular and humoral immune function in children with severe pneumonia.The clinical monitoring of immune state,such as the changes of immunoglobulin and T lymphocyte subsets,can effectively judge the condition,curative effect and prognosis of children with pneumonia.