CD4^(+)T细胞、NK细胞穿孔素异常表达对手足口病免疫状态评估及预后的指导价值

Guiding value of abnormal expression of perforin in CD4^(+)T cells and NK cells in the evaluation of immune status and prognosis for hand,foot and mouth disease

目的探究CD4+T细胞、NK细胞穿孔素(PRF)异常表达对手足口病(HFMD)患儿免疫状态和病情评估,分析其对临床预后的指导价值。方法选取2017年1月至2020年6月我院收治的143例HFMD患儿,按照病情严重程度分为普通型组(n=67)、重型组(n=45)和危重型组(n=31),另选体检正常儿童35例作为对照组,比较各组T淋巴细胞亚群(CD3+T、CD4+T、CD8+T)、CD14+单核细胞、NK细胞PRF、颗粒酶B(GrzB)、CD19+B细胞亚群、免疫球蛋白(IgA、IgG、IgM)及补体(C3、C4)水平,并分析CD4+T细胞、NK细胞PRF表达与病情严重程度(PCIS评分,PRISMⅢ评分)及预后关系。结果重症组、危重型组、普通型组患儿CD3+T、CD4+T、CD14+、CD19+B、NK细胞数及低于对照组,NK细胞PRF、GrzB表达高于对照组,其中重症组、危重型组较普通型组变化更明显,差异具有统计学意义(P <0.05);各组IgA、IgG、IgM及补体C3、C4水平差异无统计学意义(P> 0.05);Pearson相关性分析显示,CD4+T细胞与PCIS评分呈正相关(r=0.665,P <0.05),与PRISMⅢ评分呈负相关(r=-0.757,P <0.05),PRF与PCIS评分呈负相关(r=-0.615,P <0.05),与PRISMⅢ评分呈正相关(r=0.596,P <0.05);预后良好患儿CD4+T细胞高于预后不良患儿,NK细胞PRF低于预后不良患儿,差异具有统计学意义(P <0.05)。结论手足口病患儿存在明显CD4+T细胞表达过低、NK细胞PRF表达过高,两者可用于重症患儿细胞免疫状况评估,且与患儿病情严重程度和预后不良有关。

Objective evaluate the immune status and condition of children with hand-foot-mouth disease(HFMD),and to analyze its guiding value for clinical prognosis.Methods January 2017 to June 2020 were selected and divided into normal group(n = 67),severe group(n = 45)and critical group(n = 31). Another 35 children with normal findings in physical examination were selected as the control group. T lymphocyte subsets(CD3+T,CD4+T,CD8+T),monocytes(CD14+),NK cell PRF,and granzyme B(GrzB),B cell subsets(CD19+),immunoglobulins(IgA,IgG,IgM)and complement(C3,C4)levels were compared. The expression of CD4+T cells,NK cells PRF and the severity of the disease(PCIS score,PRISM Ⅲ score)as well as the prognostic relationship were analyzed.Results CD19+B,and NK cells in the severe group,critical group,and normal group were lower than those in the control group. The expressions of NK cell PRF and GrzB were higher than those in the control group where the severe group and the critical group had more obvious changes than the normal group(P < 0.05). The levels of IgA,IgG,IgM and complement C3 and C4 in each group have no significant difference(P > 0.05);Pearson correlation analysis showed that CD4+T cells were positively correlated with PCIS score(r = 0.665,P < 0.05),and negatively correlated with PRISMⅢ score(r =-0.757,P < 0.05),PRF was negatively correlated with PCIS score(r =-0.615,P < 0.05),and positively correlated with PRISMⅢ score(r = 0.596,P < 0.05). CD4+T cells in children with good prognosis were higher than those with poor prognosis,and PRF of NK cells was lower than those with poor prognosis(P < 0.05).Conclusion expression of NK cells PRF,both of which could be used to assess the cellular immune status of severely ill children and are related to the severity of the disease and poor prognosis.