川崎病患儿精细免疫分型分析及其临床意义

Immunophenotyping analysis and its clinical significance in Kawasaki disease

目的分析急性期川崎病(KD)患儿淋巴细胞各亚群的数量变化,探讨对临床诊治的意义。方法前瞻性分析重庆医科大学附属儿童医院收治的20例急性期KD患儿的临床资料以及外周血淋巴细胞各亚群(CD3^+、CD4^+及各亚群、CD8^+及各亚群、TCRαβ^+DNT、TCRγδ^+、CD4/CD8、CD19^+及各亚群、CD16^+CD56)的数量,并选取20例健康儿童为对照组,比较2组间的变化并分析临床指标与淋巴细胞各亚群的关系。结果 20例患儿的临床表现均符合典型KD的诊断标准,与对照组相比,KD组的CD8 naive、TCRαβ^+DNT、CD4/CD8、CD19^+及各亚群水平均明显升高(P<0.05),而CD4 EM(CD4^+CD45RA-effector memory T cells)、CD4 Temra(CD4^+CD45RA^+effector memory T cells)、CD8^+T、CD8 CM(CD8^+CD45RA-central memory T cells)、CD8 Temra(CD8^+CD45RA^+effector memory T cells)、CD16^+CD56水平明显降低(P<0.05)。有冠状动脉损害的KD患儿与未出现冠状动脉损害的KD患儿相比,TCRγδ^+T细胞水平明显升高(P<0.05),CD4 Temra细胞水平有下降趋势。合并呼吸道或消化道系统并发症的KD患儿与未合并呼吸道或消化道系统并发症的KD患儿相比,CD3^+T、CD8 CM、CD8 EM、CD8 Temra细胞水平明显下降(P<0.05),Transitional B细胞水平明显升高(P<0.05)。结论急性期KD患儿的T、B淋巴细胞均处于异常活化的状态,其中TCRγδ^+T和CD4 Temra细胞与川崎病合并冠状动脉损害相关,CD3^+T、CD8 CM、CD8 EM、CD8 Temra和Transitional B细胞与川崎病合并呼吸道或消化道系统并发症相关。

To analyze the quantitative alternation of lymphocyte subsets in acute period Kawasaki disease （KD） and its significance in clinical diagnosis and treatment, we collect and prospectively analyzed the clinical data of 20 patients with acute KD, who were treated in Children＇ s Hospital of Chongqing Medical University, with 20 healthy children as control group. The levels of lymphocyte subsets （CD3＋, CD4＋ and CD4＋ subsets, CD8＋ and CD8＋ subsets, TCR αβ＋DNT, TCR γδ＋,CD4/CD8, CD19＋ and CD19＋ subsets, CD16＋CD56） were compared between two groups; the relationship between clinical indicators and lymphocyte subsets was analyzed simultaneously. Data showed that compared with the control group, the levels of CD8 naive, TCR αβ＋DNT, CD4/CD8, CD19＋ and CD19＋ subsets were increased （P〈0.05） in KD group, while the levels of CD4 EM （CD4 ＋ CD45RA- effector memory T cells）, CD4 Temra （CD4＋ CD45RA＋ effector memory T cells）, CD8＋T, CD8 CM （CD8＋ CD45RA- central memory T cells）, CD8 Temra （CD8＋ CD45RA＋ effector memory T cells）, CD16＋CD56 were decreased （P〈0.05）. Inaddition, the level of TCR γδ＋T cells was increased （P〈 0.05） and CD4 Temra cells had a downward trend in KD patients with coronary artery lesions （CAL）, as compared with patients without CAL; the levels of CD3 ＋ T, CD8 CM, CD8 EM, CD8 Temra cells were decreased （P〈0.05）, while the transitional B cells was increased （P〈0.05） in KD patients with complication of respiration system or digestive system, as compared to those of nRS or nDS patients. Taken together, the function of T and B cells in patients with acute KD is abnormally activated; the TCR γδ＋T cells and CD4 Temra are related to the KD with coronary artery lesions, while the CD3＋ T, CD8 CM, CD8 EM, CD8 Temra, transitional B cells are related to the KD with complication of respiration system or digestive system.