T细胞亚群选择性缺失及体液免疫变化对儿童重症手足口病发生发展的影响

Effects of selective deficiency of T cell subgroups and humoral immunity change on occurrence and development of severe hand-foot-mouth disease in children

目的探讨T细胞亚群选择性缺失及体液免疫变化在儿童重症手足口病发生发展中的作用,为临床治疗及预后评估提供依据。方法选取2010年5月-2013年5月该院PICU收治的重症手足口病患儿185例及同期在门诊治疗的普通手足口病患儿32例为研究对象,将上述患儿分为危重组(37例)、重症组(148例)和普通组(32例)。采用流式细胞仪检测各组儿童CD3^+、CD4^+、CD8^+、CD19^+、CD56^+及CD4^+/CD8^+水平,应用单向免疫扩散法测定其血清IgG、IgM、IgA、C_3及C_4水平。比较各组患儿细胞免疫(T细胞亚群)及体液免疫(IgG、IgM、IgA)水平的差异。结果 3组患儿CD3^+、CD4^+、CD19^+T细胞数量及CD4^+/CD8^+比较,差异有统计学意义(P<0.05)。CD8^+及CD56^+T细胞数量比较,差异无统计学意义(P>0.05)。3组患儿IgG、IgM、IgA均存在异常,差异有统计学意义(P<0.05)。结论 T细胞亚群选择性缺失及体液免疫变化在儿童手足口病发生发展中起关键作用,T细胞免疫功能抑制与重症手足口病的不良预后相关。

Objective To explore the effects of selective deficiency of T cell subgroups and humoral immunity change on occurrence and development of severe hand-foot-mouth disease （HFMD） in children, provide a basis for clinical treatment and prognosis assessment. Methods A total of 185 hospitalized children with severe HFMD in PICU and 32 outpatient children with ordinary HFMD were se- lected from the hospital from May 2010 to May 2013 as study objects, then the children were divided into critical group （37 children）, severe group （148 children）, and ordinary group （32 children） . Flow cytometry was used to detect the levels of CD3^＋, CD4^＋, CD8^＋, CD19^＋ , CD56^＋ cells, and CD4^＋/CD8^＋ ratios in the three groups ; simple immunodiffusion method was used to detect the levels of serum IgG, IgM, IgA, C3, and C4. The differences of cellular immunity （T cell subgroups） and humoral immunity （IgG, IgM, IgA） levels were compared among the three groups. Results There were statistically significant differences in the numbers of CD3^＋, CD4^＋, CD19^＋ T cells and CD4^＋/CD8^＋ ratio among the three groups （P〈0.05） . There was no statistically significant difference in the numbers of CD8^＋ and CD56^＋ T cells among the three groups （P〉0.05） . IgG, IgM, and IgA levels were abnormal, there were statistically significant differences among the three groups （P〈0. 05） . Conclusion Selective deficiency of T cell subgroups and humoral immunity change play key roles in occurrence and development of severe HFMD of children, T cell immune function inhibition is related to adverse prognosis of severe HFMD.