呼吸道病毒感染对支气管哮喘患儿Th1/Th2细胞因子平衡的影响

Effect of respiratory viral infection on Th1/Th2 cytokines balance in children with bronchial asthma

目的探讨呼吸道病毒感染对支气管哮喘患儿Th1/Th2细胞因子平衡的影响。方法选择2016年3月～2018年2月海口市妇女儿童医院收治的支气管哮喘患儿153例,另选择同期健康儿童69名为对照。统计支气管哮喘患儿呼吸道病毒感染类型,比较受试儿童外周血Th1、Th2、Th1/Th2比值、气道功能[1 s用力呼气量(FEV1)、用力肺活量(FVC)、最大呼气流速(PEFR)和FEV1/FVC]及血气指标[动脉血氧分压(PaO_2)和二氧化碳分压(PaCO_2)],另外分析支气管哮喘患儿外周血Th1、Th2、Th1/Th2比值与气道功能及血气指标的相关性。结果支气管哮喘患儿中呼吸道病毒感染阳性率为66.67%(102/153),其中腺病毒(AV)21例、流感病毒(IFV)27例、副流感病毒(PIV)24例及呼吸道合胞病毒(RSV)30例;支气管哮喘患儿外周血Th1、Th1/Th2比值、FEV1、FVC、PEFR、FEV1/FVC及PaO_2均明显低于健康儿童(P <0.05),而Th2细胞含量和PaCO_2明显高于健康儿童(P <0.05);IFV感染患儿、RSV感染患儿外周血Th1、Th1/Th2比值均明显低于单纯哮喘患儿(51例)(P <0.05),而Th2明显高于单纯哮喘患儿(P <0.05);支气管哮喘合并呼吸道病毒感染患儿FEV1、FVC、PEFR、FEV1/FVC及PaO_2均明显低于单纯哮喘患儿(P <0.05),而PaCO_2显著高于单纯哮喘患儿(P <0.05)。支气管哮喘患儿外周血Th1和Th1/Th2与FEV1、PEFR、FEV1/FVC及PaO_2呈正相关(P <0.05),而与PaCO_2呈负相关(P <0.05);同时外周血Th2与PaCO_2呈正相关(P <0.05),而与PEFR、FEV1/FVC及PaO_2呈负相关(P <0.05)。结论呼吸道病毒感染影响支气管哮喘患儿Th1/Th2细胞因子平衡,抑制Th1细胞功能,激活Th2细胞功能,其中PSV和IFV影响更明显。

Objective To investigate the effect of respiratory viral infection on Th1/Th2 cytokines balance in children with bronchial asthma.Methods From March 2016 to February 2018,in Haikou Women′s and Children′s Hospital,153 children with bronchial asthma were selected,and another 69 healthy children at the same period were selected as the control.The respiratory viral infection types of children with bronchial asthma were statistically analyzed,and the ratio of Th1,Th2 and Th1/Th2 in peripheral blood of children,airway function[forced expiratory volume at 1 second(FEV1),and forced vital capacity(FVC),peak expiratory flow rate(PEFR)and FEV1/FVC]and blood gas index[blood oxygen partial pressure(PaO2)and partial pressure of carbon dioxide(PaCO2)]of the children were compared.In addition,the correlation among the ratio of Th1,Th2 and Th1/Th2 in peripheral blood and airway function and blood gas index in children with bronchial asthma was analyzed.Results The positive rate of respiratory viral infection in children with bronchial asthma was 66.67%(102/153),there were 21 cases of adenovirus(AV),27 cases of influenza virus(IFV)group 24 cases of parainfluenza virus(PIV),30 cases of respiratory syncytial virus(RSV).Th1,Th1/Th2,FEV1,FVC,PEFR,FEV1/FVC and PaO2 of children with bronchial asthma were significantly lower than healthy children(P<0.05),Th2,PaCO2 were significantly higher than healthy children(P<0.05);Th1,Th1/Th2 in IFV children and RSV children were significantly lower than simple asthma children(P<0.05),Th2 was significantly higher than simple asthma children(P<0.05).The FEV1,FVC,PEFR,FEV1/FVC and PaO2 in children with bronchial asthma complicated with respiratory virus infection were significantly lower than simple asthma children(P<0.05),PaCO2 was significantly higher than simple asthma children(P<0.05).Th1,Th1/Th2 was positively correlated with FEV1,PEFR,FEV1/FVC and PaO2(P<0.05),but negatively correlated with PaCO2(P<0.05);Th2 was positively correlated with PaCO2(P<0.05),Th2 was negatively correlated with PEFR,FEV1/FVC and PaO2(P<0.05).Conclusion Respiratory virus infection affects Th1/Th2 cytokines balance in children with bronchial asthma,it inhibits Th1 cell function and activates Th2 cell function,PSV and IFV have more obvious effect among them.