儿童难治性肺炎支原体肺炎免疫机制探讨

Discussion of immune mechanism of children refractory mycoplasma pneumoniae pneumonia

目的探讨儿童难治性支原体肺炎的免疫功能变化。方法选择2014年1月~2015年5月在河北省儿童医院治疗的难治性支原体肺炎患儿47例(难治性组)、普通支原体肺炎患儿50例(普通组)以及健康体检儿童50例(对照组)为研究对象。采用流式细胞仪以及免疫透射比浊法检测所有研究对象T淋巴细胞亚群以及外周血免疫球蛋白水平,分析儿童难治性肺炎支原体肺炎的免疫机制。结果难治性组患儿血清IgG、IgM、CD8^+、CD19^+均显著高于对照组,CD3^+、CD4^+、CD4^+/CD8^+、CD16^+、CD56^+均显著低于对照组,差异均有高度统计学意义(P<0.01);普通组患儿血清IgG、IgM、CD8^+、CD19^+均显著高于对照组,CD4^+、CD4^+/CD8^+均显著低于对照组,差异均有统计学意义(P<0.05或P<0.01);难治性组患儿血清CD3^+、CD4^+/CD8^+、CD16^+CD56^+均显著低于普通组患儿,CD19^+显著高于普通组患儿,差异均有高度统计学意义(P<0.01)。难治性组患儿经治疗后2个月复查,血清IgG、IgA、IgM、CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、CD19^+、CD16^+CD56^+水平与治疗前比较差异无统计学意义(P>0.05)。结论体液免疫及细胞免疫均参与了儿童难治性肺炎支原体肺炎的发病,患儿存在免疫功能紊乱,并且持续时间较长。

Objective To discuss the immune mechanism of children refractory mycoplasma pneumoniae pneumonia （RMPP）. Methods From Jan 2014 tO May 2015, 47 cases with RMPP （RMPP group）, 50 eases with MPP （MPP group） and 50 healthy children （control group） in Children＇s Hospital of Hebei Provinee were selected as study subjects. Peripheral blood T lymphocyte subsets and immunoglobulin levels were detected with flow eytometry and immune turbidimetry, and the immune mechanism of children refractory myeoplasma pneumoniae pneumonia was analyzed. Results Serum levels of IgG, IgM, CD8^＋, CD19^＋ of the RMPP group were higher than those of the control group, and serum levels of CD3^＋, CD4^＋, CD4^＋/CD8^＋, CD16^＋ CD56^＋ were lower than those of the control group, the differences were statistically significant （P 〈 0.01）; serum levels of IgG, IgM, CD8^＋, CD19^＋ of the MPP group were higher than those of the eontrol group, and CD4^＋, CD4^＋/CD8^＋ were lower than control group, the differences were statistically significant （P 〈0.05 or P 〈 0.01）; serum levels of CD3^＋, CD4^＋/CD8^＋, CD16^＋ CD56^＋ of the RMPP group were lower than those of the MPP group, and CD19^＋ was higher than that of the MPP group, the differences were statistically significant （P 〈 0.01）. Two months after treatment, serum levels of IgG, IgA, IgM, CD3^＋, CD4＋, CD8^＋, CD4^＋/CD8＋, CD19^＋, CD16^＋ CD56^＋ of the RMPP group showed no difference with those before treatment （P 〉 0.05）. Conclusion Both humoral immunity and cell-mediated immunity are involved in the pathogenesis of RMPP. Children with RMPP combine with the presence of immune dysfunction, and long duration.