反复呼吸道感染患儿Th1/Th2变化及其与血清IgA相关性

Change of Th1/Th2 in children with recurrent respiratory infection and its relationship with IgA

目的探讨反复呼吸道感染患儿Th1/Th2迁移变化及其与血清IgA的相关性,力图从Th1/Th2细胞因子迁移及其与血清IgA相互关系的角度阐述反复呼吸道感染的病理机制。方法选择2014年1月至2017年1月广州市番禺区何贤纪念医院儿科收治住院的反复呼吸道感染患儿45例为观察组,同期选择本院急诊收治的上呼吸道感染患儿60例为对照组(随访期1年,1年中仅有1～4次上呼吸道感染者)。采用流式细胞仪检测患儿外周单核细胞Th1(CD3^+CD8^-IFN-γ^+IL-4^-)和Th2(CD3^+CD8^-IL-4^+IFN-γ^-)细胞比例,采用ELISA检测血清IgA水平,并采用Pearson直线相关分析其相关性。结果两组血常规指标白细胞总数、血小板计数和中性粒细胞绝对值比较差异无统计学意义(P>0.05);反复呼吸道感染患儿急性期Th1/Th2迁移明显,表现为Th1比例下降,Th2升高,同时IgA水平升高,与对照组比较差异有统计学意义(P<0.05);随着Th2比例增加,IgA水平增加,相关分析显示IgA与Th2变化呈正相关(r=0.745,P=0.001)。结论反复呼吸道感染患儿急性期Th1/Th2迁移明显,以Th2占优势,并与血清IgA呈正相关,免疫稳态失衡是该疾病发病的重要因素,临床应予以重视。

Objective To study the serum IgA in the effect of Th1/Th2 migration in children with recurrent respiratory infection.Methods A total of 45 children with recurrent respiratory infection treated in Hexian Memorial Hospital from Jan. 2014 to Jan. 2017 were selected as the observation group,and 60 children with upper respiratory infection treated in our hospital during the same period were included as the control group（with one-year follow up and only one to 4 times of infection in one year）.Flow cytometry was used to determine the ratio of Th1（CD3~＋CD8^-IFN-γ~＋IL-4^-）and Th2（CD3~＋CD8^-IL-4~＋IFN-γ^-）;ELISA was adopted to determine serum level of IgA,and Pearson linear correlation was used to analyze their correlation.Results Blood routine indexes were of no statistical difference between the two groups（P〈0.05）.The children with recurrent respiratory infection at acute stage had Th1/Th2 migration,characterized by Th1 decline and Th2 increase,and at the same time IgA levels increased too（P〈0.05）.With the increase of Th2,IgA levels increased too.Correlation analysis showed that IgA and Th2 changes were positively correlated（r=0.745,P=0.001）.Conclusion Children with recurrent respiratory tract infections at acute stage have Th1/Th2 migration,and Th2 is predominant,which is positively related to the serum IgA levels.The immune imbalance is an important factor of the onset of the disease,which should be attached importance to clinically.