肺炎支原体感染对手足口病患儿免疫及细胞因子水平的影响分析

Influence of Mycoplasma pneumoniae infection on immune state and levels of cytokines of children with hand,foot,and mouth disease

目的探讨肺炎支原体(MP)感染对手足口病患儿免疫功能及细胞因子水平的影响,以提高临床诊治水平。方法选取2013年1月-2015年12月住院确诊为手足口病合并MP感染的患儿34例作为感染组,取同期住院确诊手足口病且未感染MP患儿40例作为未感染组,其中感染组根据MP滴度包括高滴度患儿(>1:160)和低滴度患儿(≤1:160);比较各组患儿间的淋巴细胞亚群、免疫球蛋白及细胞因子水平。结果感染组CD_4^+、CD_8^+水平较未感染组低,而IgG水平更高(P<0.05);感染组IL-6、TNF-α水平较未感染组高(P<0.05);合并MP感染者中,高滴度患儿CD_3^+、CD_4^+、CD_8^+水平较低滴度患儿低,而CD_(19)^+、IgG水平更高(P<0.05);而高滴度患儿IL-6、IL-8、IL-10、TNF-α水平均较低滴度患儿高(P<0.05)。结论手足口病合并MP感染后,存在细胞免疫抑制,体液免疫激活,炎症反应剧烈,而且MP滴度越高者,免疫功能更为紊乱,炎症反应更剧烈,应引起临床重视。

OBJECTIVE To explore the influence of Mycoplasma pneumoniae infection on immune state and levels of cytokines of children with hand, foot, and mouth disease so as to improve the level of clinical diagnosis and treatment. METHODS A total of 34 hand, foot, and mouth disease children complicated with M. pneumoniae infec- tion who were hospitalized from Jan 2013 to Dec 2015 were enrolled in the study and set as the infection group, meanwhile, 40 children who were diagnosed with hand, foot, and mouth disease but did not have the M. pneu- moniae infection were assigned as the non-infection group. The children in the infection group were divided into the high titers group （1..160） and the low titers group（l：160） according to the M. pneumoniae titers. The levels of lymphocyte subsets, immune globulin, and cytokines were observed and compared. RESULTS The levels of CD4^ ＋ and CD8^ ＋ of the infection group were lower than those of the non-infection group, however, the level of IgG was even higher （P〈0.05）. The levels of IL-6 and TNF-α of the infection group were higher than those of the non-in- fection group （P〈0.05）. Among the children complicated with M. pneumoniae infection, the levels of CD3 ^＋ , CD4 ^＋ , and CD8 ^＋ of the children with high titers of MP were lower than those of the children with low titers of MP, however, the levels of CD19^＋ and IgG were even higher （P〈0.05） ; however, the levels of IL-6, IL-8, IL- 10, and TNF-α of the children with high titers of MP were higher than those of the children with low titers of MP （P〈0.05）. CONCLUSION The hand, foot, and mouth disease children eomplicated with M. pneumoniae infection have the cellular immunosuppression, humoral immunity aetivation, or severe inflammatory reaction; the higher the titers of MP, the more serious ＇the immune dysfunction is, the more severe the inflammatory reaction is, to which the hospital should attach great importance.