EV71型手足口病患儿外周血淋巴细胞亚群与血小板相关性研究

The Relationship between Peripheral Blood Lymphocyte Subsets and Platelets in Patients with EV71 Infection Hand-foot-mouth Disease

目的探讨肠道病毒71型(EV71)手足口病患儿外周血淋巴细胞亚群与血小板之间的相关性。方法选取2012年3~8月徐州市儿童医院感染性疾病科确诊为手足口病且大便反转录聚合酶链反应检测EV71核糖核酸阳性的患儿77例,根据卫生部《手足口病诊疗指南(2010~年版)》诊断指标分为普通组(不合并中枢神经系统感染)25例和重症组(合并中枢神经系统感染)52例。检测血小板、淋巴细胞总数以及CD_3^+T、CD_4^+T、CD_8^+T、CD_4^+/CD_8^+、自然杀伤细胞(NK)、B淋巴细胞亚群比例。结果重症组手足口病患儿外周血血小板、淋巴细胞计数均高于普通组[(347±101)×10~9/L比(273±87)×10~9/L;3.6(2.7,4.8)×10~9/L比2.9(1.9,3.5)×10~9/L];重症组患儿外周血CD_3^+T细胞、CD_8^+T细胞比例均低于普通组[(47.09±11.06)%比(56.42±11.59)%;22.96(19.77,28.65)%比30.67(22.15,37.97)%],差异有统计学意义(P<0.05)。重症组B细胞比例高于普通组[41.62(27.27,50.44)%比24.10^(21.17,35.15)%],差异有统计学意义(P<0.05)。两组外周血白细胞计数和NK、CD_4^+T、CD_4^+/CD+8细胞比例差异无统计学意义(P>0.05)。77例手足口病患儿血小板计数与CD_3^+T细胞比例呈负相关(r=-0.475,P<0.05),与B细胞比例呈正相关(rs=0.483,P<0.05)。结论血小板影响手足口病患儿免疫功能,血小板与重症手足口病的发病有关。

Objective To investigate the relationship between peripheral blood lymphocyte subsets and platelets in patients with enterovirus 71（ EV71） infection hand-footmouth disease. Methods A total of 77 patients with hand-foot-mouth disease in Infectious Disease Department of Xuzhou Children＇ s Hospital from Mar. 2012 to Aug. 2012 were included in the study,whose EV71 RNA was positive in stools by reverse transcription polymerase chain reaction. The patients were divided into 25 cases of common group（ without central nervous system infections） and 52 cases of severe group（ combined with central nervous system infections）according to the diagnosis index of〈Hand-foot-mouth Disease Diagnosis and Treatment Guideline（ 2010~ Edition） 〉of Ministry of Health. The total number of platelets and lymphocytes subset CD_3~＋T,CD_8~＋T,CD_4~＋T,CD_4~＋/ CD_8~＋,NK,B cell were detected by flow cytometry,and the differences among the groups were analyzed. Results The platelet count and the absolute value of lymphocyte in the severe group were higher than the common group[（ 347±101）×10^9/Lvs（273±87）×10^9/ L; 3. 6（ 2. 7,4. 8） × 10^9/ L vs 2. 9（ 1. 9,3. 5） × 10^9/ L]. The proportion of peripheral blood CD_3~＋T cells and CD_4~＋T cells in the severe group were lower than the common group [（ 47. 09 ± 11. 06） % vs（ 56. 42 ± 11. 59） %; 22. 96（ 19. 77,28. 65） % vs30. 67（ 22. 15,37. 97） % ],the differences were statistically significant. The proportion of B cells in the severe group was higher than the common group[41. 62（ 27. 27,50. 44） % vs 24. 10^（ 21. 17,35. 15） % ],the difference was statistically significant. There was no significant difference in the number of peripheral blood WBC and NK,CD_4~＋T and CD_4~＋/ CD_8~＋cells. In all 77 cases,the number of platelet count in children with hand-foot-mouth disease was negatively correlated with the proportion of CD_3~＋T cells（ r =- 0. 475,P 〈0. 05）,and it was positively correlated with the proportion of B cells（ rs= 0. 483,P〈 0. 05）. Conclusion Platelets influence the immune function of children with hand-foot-mouth disease,which is associated with the onset of severe hand-foot-mouth disease.