维生素D辅助治疗对重症毛细支气管炎患儿runt相关转录因子3及Th17/Treg相关细胞因子影响观察

Influence of Vitamin D Adjuvant Therapy on Runt-related Transcription Factor 3 and Th17/Treg-related Cytokines in Children with Severe Bronchiolitis

目的:观察维生素D辅助治疗对重症毛细支气管炎患儿runt相关转录因子3(Runx3)及Th17/Treg相关细胞因子的影响。方法:104例重症毛细支气管炎患儿随机分为常规治疗组和维生素D治疗组各52例。常规治疗组给予利巴韦林和布地奈德治疗,维生素D治疗组在常规治疗组基础上加用维生素D,两组均连续治疗14 d。比较两组临床疗效,以及两组患儿治疗前后外周血单核细胞(PBMC)中Runx3 mRNA的表达情况,Th17/Treg、血清中1,25-(OH)2-D3、IL-6、IL-8水平及T淋巴亚群细胞水平变化。结果:两组临床总有效率差异无统计学意义(P>0.05)。治疗后,两组患儿PBMC中Runx3 mRNA表达水平和Treg比例均较治疗前明显升高,外周血CD3+、CD3+CD4+ T细胞浓度及CD4+/CD8+均较治疗前增加,Th17比例、Th17/Treg及血清IL-6、IL-8水平均较治疗前降低(P<0.05);且维生素D治疗组上述指标均优于常规治疗组(P<0.05)。治疗后维生素D治疗组的血清1,25-(OH)2-D3水平较治疗前明显升高,且高于常规治疗组(P<0.05)。结论:在常规治疗基础上外源性补充维生素D可更有效地改善重症毛细支气管炎患儿Th17/Treg失衡,增强患儿PBMC中Runx3 mRNA的表达,提高机体免疫功能,减轻炎症反应。

Objective:To investigate the influence of vitamin D adjuvant therapy on runt-related transcription factor 3(Runx3) and Th17/Treg-related cytokines in children with severe bronchiolitis. Methods:104 children with severe bronchiolitis were divided into the conventional treatment group and the vitamin D treatment group according to the random number table method, 52 cases in each group. The conventional treatment group was given ribavirin and budesonide treatment, the vitamin D treatment group was treated with vitamin D on the basis of the conventional treatment group, both groups were treated for 14 days. The clinical efficacy, expression of Runx3 mRNA in PBMC, Th17/Treg, serum levels of 1, 25-(OH)2-D3, IL-6, IL-8 and T lymphocyte subsets before and after treatment were compared between the two groups. Results: After treatment, there was no statistically significant difference in the total clinical effective rate between the two groups of children(P>0.05). Compared with before treatment, the expression levels of Runx3 mRNA in PBMC, the ratio of Treg of the two groups significantly increased after treatment, the peripheral blood CD3+, CD3+CD4+ T cell concentration and CD4+/CD8+ increased, the ratio of Th17, Th17/Treg and the levels of serum IL-6 and IL-8 decreased(P<0.05), and the above indicators in the vitamin D treatment group were better than those in the conventional treatment group(P<0.05). The level of serum 1, 25-(OH)2-D3 in the vitamin D treatment group after treatment was significantly higher than before treatment and the conventional treatment group(P<0.05).Conclusion:Exogenous vitamin D supplementation on the basis of conventional treatment can more effectively improve Th17/Treg imbalance in children with severe bronchiolitis, enhance the expression of Runx3 mRNA in PBMC, improve immune function, and reduce inflammation.