手足口病患儿早期抗炎-促炎机制及免疫功能变化的研究

Study on the Earlier Inflammatory and Antiinflammatory and Immune Mechanism Change of Children With Hand,Foot and Mouth Disease

目的探讨手足口病(HFMD)患儿的肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-10及免疫功能的变化。方法选择2012年5月至10月于山东省即墨市人民医院儿科手足口病门诊就诊及住院治疗的首次确诊为HFMD患儿56例为研究对象,并将其纳入实验组。随机选择同期于本院行健康体检的20例健康儿童纳入对照组。两组儿童的性别、年龄等一般临床资料比较,差异无统计学意义(P>0.05)。检测两组儿童免疫球蛋白(Ig)A、IgG、IgM,T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)及血清TNF-α、IL-6、IL-10水平(本研究遵循的程序符合山东省即墨市人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书)。结果实验组与对照组IgA、CD4+、IL-6、IL-10水平比较[(1.06±0.61)g/L vs(1.50±0.54)g/L,(30.79±8.87)%vs(35.15±5.18)%,(14.71±16.29)pg/mL vs(3.76±1.03)pg/mL,(15.38±8.77)pg/mLvs(11.39±4.99)pg/mL],差异均有统计学意义(t=2.849,2.070,2.991,1.921;P<0.05)。重症HFMD患儿与普通型HFMD患儿IL-6、IL-10水平比较[(8.02±8.91)pg/mL vs(16.75±18.01)pg/mL,(23.17±10.06)pg/mL vs(11.86±7.01)pg/mL],差异均有统计学意义(t=1.792,4.739;P<0.05)。IL-6与IgG、IgM有明显相关关系(r=0.411,0.899;P<0.05);IL-10与IgA有明显相关关系(r=-0.325,P<0.05)。IL-6与CD3、CD4水平有明显相关关系(r=0.720,0.764;P<0.05)。结论 HFMD患儿于发病初期即存在免疫功能紊乱,特别是IgA和CD4+水平下降,并存在抗炎-促炎机制失衡,其水平变化可能是重症HFMD患儿发病的重要原因之一。

Objective To investigate the changes of tumor necrosis factor（TNF）-α,interleukin（IL）-6,IL-10 and immun functions of children with hand,foot and mouth disease（HFMD）.Methods Fiftysix out-patients and in-patients who were diagnosed as HFMD in the department of Pediatrics,People′s Hospital of Jimo City from May to October 2012,were included into this study as experiment group.At the same time,another 20 healthy children were recruited into this study as control group.There were no significant differences on age and gender between two groups（P〉0.05）.The levels of following items were detected of two groups：immunoglobulin（Ig）A,IgG,IgM,T cell subgroup（CD3^＋,CD4^＋,CD8^＋,CD4^＋/CD8^＋）and cytokines（TNF-α,IL-6,IL-10）.The study protocol was approved by the Ethical Review Board of Investigation of People′s Hospital of Jimo City.Informed consent was obtained from all participates′patients.Results The significant differences were found in the levels of IgA,CD4^＋,IL-6and IL-10 between experiment group and control group[（1.06±0.61）g/L vs（1.50±0.54）g/L,（30.79±8.87）%vs（35.15±5.18）%,（14.71±16.29）pg/mL vs（3.76±1.03）pg/mL,（15.38±8.77）pg/mL vs（11.39±4.99）pg/mL]（t=2.849,2.070,2.991,1.921;P〈0.05）.There were significant differences in IL-6,IL-10 between severe HFMD patients and common HFMD patients [（8.02±8.91）pg/mL vs（16.75±18.01）pg/mL,（23.17±10.06）pg/mL vs（11.86±7.01）pg/mL]（t=1.792,4.739;P〈0.05）.There was a positive correlation between IL-6 and IgG,IgM（r=0.411,0.899;P〈0.05）,IL-10 and IgA（r=-0.325,P〈0.05）,IL-6 and CD3,CD4（r=0.720,0.764;P〈0.05）.Conclusions The immune function disorder was found at the early stage of HFMD,especially the decline of IgA and CD4^＋ levels.Furthermore,the inflammatory and antiinflammatory mechanism disorder may play an important role in the development of severe HFMD.