T细胞免疫及细胞因子在川崎病不同时期表达变化的研究

Study on the T cell immunity and cytokine expression changes in different periods of Kawasaki disease patients

目的探讨川崎病(kawasaki disease,KD)时细胞免疫功能及一些细胞因子在疾病发生发展中的变化。方法 2015年1月至2016年12月在我院住院的KD患者50例、感染发热对照组48例、正常对照组45名,采用酶联免疫吸附试验(enzym e-linked imm unosorbentassay,ELISA)检测三组血清巨噬细胞迁移抑制因子(macrophagem igration inhibitory factor,MIF)、白细胞介素-2(interleukin-2,IL-2)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-10(interleukin-10,IL-10)、肿瘤坏死因子α(tumornecrosis factor-α,TNF-α)水平,采用流式细胞术检测川崎病患者的细胞免疫功能。其中川崎病患者分别于急性期(发病第1~11d)、亚急性期(发病第11~21d)与恢复期(21d以后)各检测一次。结果川崎病急性期T淋巴细胞CD3、CD4、CD4/CD8、CD25明显增高,CD8比例减少;川崎病亚急性期、恢复期CD3、CD4、CD4/CD8、CD8、CD25较急性期恢复;川崎病患儿急性期血清MIF、IL-2、IL-6、TNF-α水平明显升高,IL-10水平明显降低;川崎病患儿亚急性期、恢复期血清MIF、IL-2、IL-6、IL-10、TNF-α水平较急性期明显恢复,CD4、CD4/CD8、CD25、TNF-α明显高于冠状动脉正常组,IL-6、IL-10明显低于冠脉正常组。结论川崎病急性期细胞免疫系统处于活化状态,活化的T细胞既可分泌高浓度的炎性细胞因子如MIF、IL-2、IL-6、TNF-α等,亦可引起IL-10降低,从而引起一系列的血管炎性改变和脏器损伤,冠状动脉病变患儿在亚急性期和恢复期仍有持续较长时间的免疫失衡。

Objective To investigate cell immune function and cytokine expression changes in different periods of Kawasaki disease patients. Methods Serum samples were collected from 50 patients with KD,48 febrile control subjects, and 45 normal healthy subjects, respectively. The serum levels of CD3, CD4 ,CD8 and CD25 positive T cell was detected by flow cytometry. Cytokines,incIuding MIF, IL2, IL-6, ILl0 and TNF-a were assayed by ELISA. KD Pa tients were detected one time in acute stage （incidence at 1-11 days）,subacute stage （incidence of 11-21 days） and recovery period （after 21 days）. Results The absolute counts of CD3 ,CD4 ,CD4/CD8 and CD25 were increased while the absolute counts of CD8 T cells decreased in KD during the acute stage （P^0.05）. The level of CD3 ,CD4 ,CD4/ CD8,CD8 and CD25 significantly recovered in the subacute stage and he recovery period of Kawasaki disease（P~ 0.05） ;The absolute counts of MIF,IL2, IL6 and TNF-a were increased while the absolute counts of II.10 decreased in KD during the acute stage （P^0.05）. The level of MIF,IL2,IL6,IL10 and TNF-a significantly recovered in the subacute stage and he recovery period of Kawasaki disease（P〈~0.05）; There was significant difference between the coronary artery disease group normal and coronary artery control group in CD4, CD4/CDS, CD25, II.-6, IL-10, TNF- a （P%0. 05） ,the levels of CD4,CD4/CD8,CD25 and TNF-a in the coronary artery lesion group were significantly higher than those in the normal coronary artery group,and the IL-6 and IL-10 levels were significantly lower than those in the normal coronary artery group. Conclusion The immune system cells are activated in Kawasaki disease,a cute stage,inflammatory cytokine activated T cells can secrete high concentration such as MIF, IL 2,IL-6, TNF- etc can cause the decrease of I1.-10, resulting in a series of vasculitic changes and organ damage. There is still a long du- ration of immune imbalance in subacute and convalescent coronary artery disease patients.