儿童重症结核病的免疫功能检测及其临床意义

Immunity function detection in pediatrics with severe tuberculosis and its clinical significance

目的分析细胞免疫和体液免疫功能检测在儿童重症结核病中的临床价值。方法将2018年6月至2019年6月南华大学附属长沙中心医院儿童结核科及儿童重症监护室收治的153例初治结核病儿童作为研究对象,根据病情分成普通结核病组103例和重症结核病组50例,比较两组儿童T细胞(CD3^+T细胞、CD4^+T细胞、CD8^+T细胞)、B细胞(CD19^+)、NK细胞(CD56^+)、补体C3和C4、免疫球蛋白(IgG、IgM、IgA)及IgE的水平。结果与普通结核病组儿童比较,重症结核病组儿童的CD3^+T细胞、CD4^+T细胞比率明显下降,IgG、IgA、IgE水平明显上升,差异均有统计学意义(P<0.05),而两组儿童的CD8^+T细胞、B细胞、NK细胞比率比较差异均无统计学意义(P>0.05);同时两组儿童的补体C3、补体C4及IgM表达水平比较差异均无统计学意义(P>0.05)。结论重症结核病组儿童对比普通结核病组儿童细胞免疫受到更大损害,因此细胞免疫功能检测可有效判断患儿病情及风险,有助于指导重症结核病的治疗。

Objective To analyze the clinical significance of cellular immunity and humoral immunity function detection in pediatrics with severe tuberculosis(TB). Methods From June 2018 to June 2019, 153 children with newly diagnosed TB admitted to the Department of Pediatrics Tuberculosis or Pediatric Intensive Care Unit, Affiliated Changsha Central Hospital, University of South China were enrolled. According to the condition, they were divided into the general TB group with 103 children and severe TB group with 50 children. The T cells(CD3^+T cell, CD4^+T cell,CD8^+T cell), B cell(CD19^+), NK cell(CD56^+), complement C3 and C4, immunoglobulin(IgG, IgM, IgA), and IgE level were compared between the two groups. Results Compared with children in the general TB group, the ratio of CD3^+T cells and CD4^+T cells in children with severe TB group decreased significantly, and the levels of IgG, IgA, and IgE increased significantly(P<0.05). There was no statistically significant difference in the ratio of CD8^+T cells, B cells, and NK cells between the two groups(P>0.05);meanwhile, the expression levels of complement C3, complement C4, and IgM in the two groups of children were not statistically significant(P>0.05). Conclusion The severe TB children suffered more damage to humoral immunity as compared with the general TB children. Therefore, humoral immunity function status detection can effectively determine the condition and risk of children, and it can help guide the treatment of severe TB.