高原地区脑性瘫痪患儿免疫功能状态及康复治疗对其的影响

Immune function status of children with cerebral palsy in plateau area and the influence of rehabilitation treatment

目的观察高原地区脑性瘫痪(CP)患儿体液和细胞免疫功能,以及在综合康复治疗过程中的水平变化。方法选取2018年6月至2019年10月西宁市中医院收治的144例CP患儿(CP组)进行综合康复治疗,连续治疗3个疗程。治疗前后,采用免疫比浊法、流式细胞术、电化学发光分析法检测其外周血免疫球蛋白IgA、IgG、IgM及补体(C3、C4)、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)和神经元特异性烯醇化酶(NSE)含量,并依据粗大运动功能分级系统(GMFCS)、粗大运动功能测试量表(GMFM-88)对不同程度的患儿进行分级和康复疗效评估。另选取50名同期体检的健康儿童作为对照组。采用χ^(²)检验和独立样本t检验分析两组一般资料的差异。结果CP组体液免疫IgG、IgA、IgM、C3、C4水平[分别为(6.42±1.05)、(0.64±0.13)、(0.89±0.13)、(0.80±0.08)和(0.17±0.03)g/L]低于对照组[分别为(10.25±0.62)、(1.04±0.06)、(1.06±0.17)、(1.04±0.04)和(0.27±0.04)g/L],不同GMFCS分级的CP患儿,体液免疫IgG、IgA水平[重度(5.40±0.69)和(0.55±0.09)g/L],[中度(6.63±0.30)和(0.66±0.14)g/L],[轻度(7.57±0.63)和(0.74±0.09)g/L]比较,差异均有统计学意义(P<0.05)。CP组T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)水平与对照组差异无统计学意义(P均>0.05)。综合康复治疗后,CP组血清中体液免疫IgG、IgA水平[(7.69±1.14)和(0.79±0.17)g/L]较治疗前上升,血清NSE低于治疗前[(12.82±2.49)μg/L比(18.57±3.08)μg/L],GMFM-88量表总分值高于治疗前[(121±27)分比(101±28)分],其差异均有统计学意义(P<0.05)。IgM、C3、C4及T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)与治疗前比较,差异均无统计学意义(P>0.05)。结论高原地区CP患儿存在体液免疫功能异常,IgG、IgA可能与CP患儿病情程度和神经元受损有关,综合康复不仅能改善CP患儿运动功能、缓解神经元损伤,还能提升其体液免疫状态。

Objective To observe the body fluid and cellular immune function of children with cerebral palsy(CP)in the plateau area,as well as the exchanges of these factors during the comprehensive rehabilitation treatment.Methods A total number of 144 children admitted to Xining Hospital of Traditional Chinese Medicine from June 2018 to October 2019 were selected as the CP group for comprehensive rehabilitation treatment(consecutive courses).The peripheral blood immunoglobulin/complement(IgA,IgG,lgM,C3,C4)level,T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+)and neuron-specific enolase(NSE)content was examined in the clinical specimens before and after treatment by using the immunoturbidimetry,flow cytometry,electrochemiluminescence analysis according to the Gross Motor Function Classification System(GMFCS)and Gross Motor Function Test Scale(GMFM-88).Children were divided as the different degrees to evaluate the rehabilitation efficacy.A total number of 50 healthy children taken a health check/physical examinations during the same period were considered as the control group.For statistical Analysis,theχ²test and independent sample t test were performed.Results The levels of humoral immune IgG,IgA,IgM,C3 and C4 in CP Group[(6.42±1.05),(0.64±0.13),(0.89±0.13),(0.80±0.08),(0.17±0.03)g/L,respectively]in CP groups′children were lower than those in the control group[(10.25±0.62),(1.04±0.06),(1.06±0.17),(1.04±0.04),(0.27±0.04)g/L,respectively].The humoral immune IgG and IgA levels[severe(5.40±0.69)and(0.55±0.09)g/L,moderate(6.63±0.30)and(0.66±0.14)g/L,mild(7.57±0.63)and(0.74±0.09)g/L,P<0.05]were also related to the children with CP of different GMFCS grades.Moreover,the level of T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+)in the CP group were not statistically different to that in the control groups children.Receiving the rehabilitation treatment,the levels of serum humoral IgG and IgA in CP Group(7.69±1.14)and(0.79±0.17)g/L were significantly enhanced;whereas the serum NSE(12.82±2.49)μg/L was lower than that before treatment(18.57±3.08)μg/L,and the total score of GMFM-88(121.35±26.51)was higher than that before treatment(101.04±27.62).The differences were statistically significant(P<0.05).IgM,C3,C4 and T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+)had no significant difference compared with those before treatment(P>0.05).Conclusions Children with CP at high altitude have abnormal humoral immune function.IgG and IgA may be related to the severity of CP and neuronal damage.Comprehensive rehabilitation can not only improve the motor function of children with CP,relieve neuronal damage,but also enhance their humoral immunity status.