儿童朗格汉斯细胞组织细胞增生症免疫状态检测及其意义

Immunological status detection in children with Langerhans cell histiocytosis

目的研究不同临床类型的朗格汉斯细胞组织细胞增生症(LCH)患儿初诊时的免疫功能变化,探讨免疫功能检测在LCH发病机制及病情预后评估中的意义。方法应用流式细胞术分析30例LCH患儿初诊时外周血各淋巴细胞亚群(T细胞、B细胞、NK细胞、NKT细胞、Th细胞、Ts细胞、Th/Ts比值、Treg细胞)比例,同时应用化学发光法检测其血清细胞因子sIL-2R、IL-6、IL-8、IL-10、IL-1β、TNF-α水平,探讨各免疫指标与LCH临床分型、器官受累类型的关系。结果肝受累组患儿的外周血T细胞及Th细胞比例均显著低于肝未受累组(P<0.05)。多系统受累(MS)组患儿的血清sIL-2R、TNF-α、IL-10水平均显著高于单系统受累(SS)组,肝受累组的血清sIL-2R、TNF-α、IL-10水平显著高于肝未受累组,肺受累组的血清sIL-2R、IL-10水平均显著高于肺未受累组(P<0.05)。其余免疫指标在不同临床分型及受累器官的初诊患者中的差异无显著性(P>0.05)。结论不同临床类型的LCH患儿存在不同程度的T细胞免疫调节紊乱。血清细胞因子sIL-2R、TNF-α、IL-10水平可在一定程度上反映LCH的疾病严重程度。

Objective A cohort study was conducted to detect the immunological status changes in children with different clinical types of Langerhans cell histiocytosis(LCH),and to explore the significance of immune function detection in the pathogenesis and prognosis evaluation of LCH.Methods The lymphocyte subsets of T,B,NK,NKT,Th,Ts,Treg cells and Th/Ts ratios were measured by flow cytometry while the serum levels of sIL-2R,IL-6,IL-8,IL-10,IL-1βand TNF-αwere measured by chemiluminescence in 30 untreated patients with LCH,and their relevance with different clinical classifications and organ involvement was analyzed.Results The proportions of T cells and Th cells in peripheral blood of children with liver involvement group were significantly lower than those of children without liver involvement group(P<0.05).The levels of serum sIL-2R,TNF-αand IL-10 in multi-system involvement(MS)group were significantly higher than those in single-system involvement(SS)group,the levels of serum sIL-2R,TNF-αand IL-10 in liver involvement group were significantly higher than those in non-liver involvement group,and the levels of serum sIL-2R and IL-10 in lung involvement group were significantly higher than those in non-lung involvement group(P<0.05).There was no statistical significance in other immune indexes among the newly diagnosed patients with different clinical types and affected organs(P>0.05).Conclusions There are varying degrees of T cell immunoregulatory disorders in LCH patients with different clinical types,and the levels of serum sIL-2R,TNF-αand IL-10 generally represent the severity of the disease.