儿童传染性单核细胞增多症异型淋巴细胞和淋巴细胞亚群与临床表现的相关性观察

Relationship between the clinical manifestations and the changes of atypical lymphocyte and lymphocyte sub-sets in children with infectious mononucleosis

目的：探讨儿童传染性单核细胞增多症（IM）异型淋巴细胞计数、淋巴细胞亚群的变化与临床表现的相互关系。方法采用回顾性的研究方法，收集确诊为 IM的住院患儿206例，分析异型淋巴细胞、淋巴细胞亚群变化和临床症状及三者相互关系。结果IM患儿 CD3^＋升高、CD3^＋ CD4^＋降低、CD3^＋ CD8^＋升高及NK 计数降低，健康对照组患儿分别为（64．23±6．26）％、（32．96±8．68）％、（20．25±7．45）％、（14．68±5．4）％，而 IM患儿分别为（84．13±14．64）％、（18．45±5．14）％、（54．46±16．82）％、（4．65±1．50）％，两组差异有统计学意义（P ＜0．001）。90．29％患儿异型淋巴细胞增高≥10％，异型淋巴细胞计数越高的患儿，淋巴细胞亚群异常越明显，异型淋巴细胞≥20％的患儿，CD3^＋ CD8^＋升高和 NK 细胞计数降低更为明显，分别为（58．78±16．67）％、（3．28±1．57）％，异型淋巴细胞＜20％＞10％与＜10％组差异有统计学意义（P ＜0．001），分别为（54．53±15．12）％、（4．55±1．64）％及（50．25±14．23）％、（5．13±1．84）％。重症 IM较轻型IM患儿及对照组患儿相比，CD3^＋ CD8^＋升高和 NK 细胞计数降低更为明显，分别为（57．78±15．45）％、（3．18±1．61）％、（51．09±12．26）％、（4．68±1．82）％、（20．25±7．45）％、（14．68±5．46）％，差异有统计学意义（P ＜0．001）。结论IM存在免疫功能异常，异型淋巴细胞的数量、CD3^＋、CD3^＋ CD4^＋、CD3^＋ CD8^＋和 NK 计数可作为病情观察监测指标。

Objective To investigate atypical lymphocyte and lymphocyte subsets in children with infectious mononucleosis（IM）and its relationship with the clinical symptoms by retrospective method.Methods Two hundred and six children were diagnosed as infectious mononucleosis.Atypical types,lymphocyte subsets,and clinical symp-toms and their relationship were evaluated and analyzed.Results In the IM children CD3^＋ increased,CD3^＋ CD4^＋ decreased,CD3^＋ CD8^＋ increased and NK cells decreased.The control group was （64.23 ±6.26 ）%,（32.96 ± 8.68）%,（20.25 ±7.45）%,（14.68 ±5.4）%,the IMgroup was （84.13 ±14.64）%,（18.45 ±5.14）%,（54.46 ± 16.82）%,（4.65 ±1.50）%,the difference was statistically significant（P 〈0.001）.92.9% patients had more 10%atypical lymphocytes.The children with more than 20% atypical lymphocytes had higher CD3^＋ CD8^＋ and NK cells decreased,（58.78 ±16.67）%,（3.28 ±1.57）%.The difference with the atypical cells more than 10% less than 20% and the group less than 10% has statistically sighnificant which were （54.53 ±15.12）%,（4.55 ±1.64）%, （50.25 ±14.23）%,（5.13 ±1.84）% （P 〈0.001）.The serious type of IM children had higher ratio of increased CD3^＋ CD8^＋ and decreased NK cells and had statistically significant compared with the light group,which were （57.78 ± 15.45）%,（3.18 ±1.61）%,（51.09 ±12.26）%,（4.68 ±1.82）%,（20.25 ±7.45）%,（14.68 ±5.46）%（P 〈0.001）.Conclusion The infectious mononucleosis can cause abnormal immune functions.The ratio of atypical lym-phocytes,CD3^＋ ,CD3^＋ CD4^＋ ,CD3^＋ CD8^＋ and NK cells numbers can be viewed as a monitoring index of the disease.