EV71型手足口病患儿脑脊液T淋巴细胞亚群测定的临床意义

Assessment of the severity and prognosis of EV71-associated HFMD by detecting the quantity of T lymphocyte subgroup in cerebrospinal fluid

目的检测肠道病毒71型(EV71)手足口病(HFMD)患儿脑脊液T淋巴细胞亚群数量,探讨其在评估病情严重程度及预后的作用。方法选取2013年6月至2014年8月深圳市龙岗中心医院儿科住院的EV71型HFMD患儿250例作为研究组,根据中华人民共和国卫生部颁发的《手足口病诊治指南(2013年版)》诊断标准分为两组,其中150例患儿无合并症作为普通组;100例患儿出现神经系统受累表现作为重症组。重症组根据治疗结果分为痊愈组、后遗症及死亡组。使用四色流式细胞仪检测250例EV71型HFMD及100例热性惊厥患儿脑脊液T淋巴细胞亚群(CD3^+CD4^+、CD3^+CD8^+、CD3^+CD56^+)的数量。结果 EV71型HFMD普通组和对照组脑脊液T淋巴细胞亚群(CD3^+CD4^+、CD3^+CD8^+)的数量比较,差异无统计学意义(P>0.05);而普通组CD3^+CD56^+的数量升高,与对照组比较,差异有统计学意义(P<0.05)。重症组脑脊液T淋巴细胞亚群(CD3^+CD4^+、CD3^+CD8^+、CD3^+CD56^+)的数量均低于普通组(P<0.05)。脑脊液T细胞亚群(CD3^+CD4^+、CD3^+CD8^+、CD3^+CD56^+)的数量在死亡组最低、后遗症组次之,痊愈组恢复至接近正常值,三组组间比较差异均具有统计学意义(P<0.05)。结论脑脊液T淋巴细胞亚群的数量变化在一定程度上与EV71型HFMD的病情严重程度及预后相关。

Objective To detect the quantity of T lymphocyte subgroup of cerebrospinal fluid in hand foot and mouth disease（HFMD） infected by enterovirus 71 （EV71）, and explore its role in assessment of the disease severity and prognosis. Methods We chose 250 children with EV71-associated HFMD in Pediatric Department of Shenzhen Longgang Central Hospital from June 2013 to August 2014 as experimental group. According to the diagnosis and guide of the hand, foot and mouth disease（2013 edition） issued by Health Ministry, all the children were divided into two groups, 150 cases of children with no complication as moderate group, and 100 cases with neurological complication as severe group. According to the results of treatment, severe group was divided into recovery, sequelae and death group. Using four-color flow cytometry instrument to detect the T lymphocyte subsets （CD3 ~ CD4 ~, CD3 ＋ CD8 ~ and CD3 ＋ CD56 ~） in 250 EV71-associated HFMD patients and 100 febrile seizures patients. Results Compared with the control group to the HFMD moderate group, there was no statistically significant difference （P〉O.05） at the level of CD3~CD4~ and CD3＋ CD8＋ T lymphocytes in cerebrospinal fluid; And the levels of CD3 ~ CD56 ~ were increased in moderate group, compared to the control group, with difference was statistically significant difference （P〈O.05）. The levels of T lymphocyte subsets （CD3 ＋ CD4 ＋, CD3 ＋ CD8 ＋ and CD3 ＋ CD56 ＊） in severe group were significant lower than moderate group（P〈0.05）. The level oft lymphocyte subsets（CD3 ＋ CD4＋, CD3 ＋CD8＋and CD3 ＋ CD56 ＋） was lowest in death group, and followed by sequelae group, recovery group was restored to near normal level, there are statistically significant difference in the three groups （P〈0.05）. Conclusion The variable level of T lymphocyte subsets to a certain extent maybe associate with the assessment of disease severity and prognosis of EV71-associated HFMD.