儿童腺病毒肺炎患儿部分细胞因子水平及临床意义

Clinical Significance of Cytokines in Children with Adenovirus Pneumonia

目的:分析不同病情腺病毒肺炎患儿血浆以及肺泡灌洗液中白细胞介素-1β(IL-1β)、IL-4、IL-5、IL-6、IL-8、IL-9、肿瘤坏死因子α(TNF-α)及干扰素γ(IFN-γ)水平。方法:腺病毒肺炎患儿36例分为轻症和重症两组,并选取同期的12例健康儿童作为对照组,采用流式细胞仪检测3组儿童血浆及轻重症组腺病毒肺炎患儿支气管肺泡灌洗液中的IL-1β、IL-4、IL-5、IL-6、IL-8、IL-9、TNF-α及IFN-γ水平。结果:与对照组比较,腺病毒肺炎患儿血浆中IL-4、IL-5、IFN-γ水平均明显降低,而TNF-α、IL-6水平明显升高(P<0.05);在急性期腺病毒肺炎患儿肺泡灌洗液中IL-1β、IL-6、IL-8、IL-9、IFN-γ水平明显高于血浆(P<0.05);轻重症患儿血浆中IL-1β、IL-6、IL-8、IL-9、IFN-γ水平比较,差异均无统计学意义(P>0.05);重症腺病毒肺炎患儿急性期肺泡灌洗液中的IL-6、IL-8、IFN-γ水平均显著高于轻症腺病毒肺炎组(P<0.05)。结论:急性期腺病毒肺炎患儿肺部炎症反应重于全身炎症反应,重症患儿肺部炎症反应更为严重,TNF-α和IL-6可能作为预测重症腺病毒肺炎的指标。

Objective:To investigate the cytokines levels in plasma and bronchoalveolar lavage fluid(BALF)in children with adenovirus pneumonia.Methods:Thirty-six children with adenoviral pneumonia were enrolled and divided into mild group and severe group.Twelve healthy children in the same period were selected as the control group.Flow cytometry was used to detect levels of cytokines including IL-1β,IL-4,IL-5,IL-6,IL-8,IL-9,TNF-αand IFN-γin plasma and BALF.Results:Compared with the control group,levels of plasma IL-4,IL-5 and IFN-γwere significantly decreased in children with adenoviral pneumonia,while levels of TNF-αand IL-6 were significantly increased(P<0.05).In acute phase,the levels of IL-1β,IL-6,IL-8,IL-9 and IFN-γin BALF were significantly higher than those in plasma in children with adenovirus pneumonia(P<0.05).There were no significant differences in the levels of plasma IL-1β,IL-6,IL-8,IL-9 and IFN-γbetween mild group and severe group(P>0.05).At the acute phase,the levels of IL-6,IL-8,IFN-γin BALF were remarkably higher in severe group than those in mild group(P<0.05).Conclusion:The pulmonary inflammatory response in children with adenovirus pneumonia at acute phase is more serious than systemic inflammatory response.The pulmonary inflammation is more serious in severe group.More importantly,the level of TNF-αand IL-6 may be used as indicators to predict severity of adenovirus pneumonia.