免疫球蛋白对HFMD合并AFP患儿的保护作用及机制

Protective effects of IVIG on hand foot and mouth disease complicating AFP and its mechanism

目的研究静脉注射人血免疫球蛋白(IVIG)对手足口病(HFMD)合并急性弛缓性瘫痪(AFP)患儿的保护作用及免疫学机制。方法受试者分为HFMD合并AFP免疫球蛋白治疗前组(治疗前组),免疫球蛋白治疗组(IVIG组),无免疫球蛋白治疗组(无IVIG组)和健康对照组(对照组),各30例。采用手法肌力评定法(MMT)检测患儿肌力,采用生物素双抗原夹心酶联免疫吸附法(ELISA)检测各组血清抗神经节苷脂M1(GM1)抗体、白细胞介素(IL)-6、IL-8、肿瘤坏死因子α(TNF-α)。结果IVIG组较治疗前组和无IVIG组的肌力恢复明显。同时,抗GM1抗体、IL-6、IL-8、TNF-α在3组HFMD合并AFP患儿中均较对照组高,而IVIG组抗GM1抗体、IL-6、IL-8、TNF-α较治疗前组和无IVIG组显著下降,差异有统计学意义(P<0.05)。结论IVIG对HFMD合并AFP患者有明显的治疗作用,其机制可能通过拮抗高水平抗GM1抗体、IL-6、IL-8、TNF-α等细胞因子,实现免疫调节作用。

Objective To study the protective effects of intravenous immunoglobulin （IVIG） on hand foot and mouth disease （HFMD） complicating acute flaccid paralysis （AFP） ,and to explore its immunological mechanism. Methods The subjects were divided into four groups in this study,including 30 cases of HFMD complicating AFP before IVIG treatment （before IVIG group）, 30 cases of HFMD complicating AFP with IVIG treatment group （IVIG group）, 30 cases of HFMD complicating AFP without IVIG treatment group （without IVIG group） ,and 30 healthy controls（normal control group）. The manual muscle test （MMT） was carried out to detect the muscle strength, the enzyme linked immunosorbent assay （ELISA） was used to test the expression of anti- GM1 antibody,IL-6,IL-8 and TNF-α. Results The muscle strength in the IVIG group was significantly improved when compared with that before IVIG and without IVIG groups. Moreover, the expressions of anti- GM1 antibody, IL-6, IL-8 and TNF-α in the IVIG group, before IVIG group and without IVIG group were increased when compared with those in the normal control group. Additionally,the expressions of anti- GM1 antibody,IL-6,IL-8 and TNF-α in the IVIG group were decreased compared with those in the hefore IVIG group and without IVIG groups（P〈0.05）. Conclusion IVIG may play an important immune-related role in relieving symptoms in children with severe HFMD complicating AFP through inhibiting the high levels of the cytokines including anti- GM1 antibody,IL-6,IL-8 and TNF-α.