轮状病毒性肠炎患儿血清1,25-(OH)_(2)D_(3)、INF-γ、CD11b水平变化及意义

Changes of serum levels of 1,25-(OH)_(2)D_(3),INF-γ,and CD11b in children with rotavirus enteritis and their clinical significance

目的探讨轮状病毒性肠炎(RE)患儿血清1,25-二羟基维生素D_(3)[1,25-(OH)_(2)D_(3)]、γ干扰素(INF-γ)、CD11b的水平变化及临床意义。方法选取RE患儿108例(RE组),根据脱水严重程度分为轻度组(n=34)、中度组(n=50)、重度组(n=24),同期选取53例体检健康儿童为对照组。采集受检者清晨空腹静脉血,用酶联免疫吸附法测定1,25-(OH)_(2)D_(3)、INF-γ,全自动特定蛋白分析仪测定免疫球蛋白A(IgA)、IgG、IgM,流式细胞仪测定CD11b和CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞百分比并计算CD4^(+)/CD8^(+),Pearson相关分析RE患儿血清1,25-(OH)_(2)D_(3)、INF-γ、CD11b水平与体液和细胞免疫指标的相关性,受试者工作特征曲线分析各指标对小儿RE的诊断价值。结果与对照组比较,RE组血清1,25-(OH)_(2)D_(3)水平低,INF-γ、CD11b水平高(P均<0.05)。轻度组、中度组、重度组血清1,25-(OH)_(2)D_(3)水平逐渐降低,INF-γ、CD11b水平逐渐升高(P均<0.05)。与对照组比较,RE组IgA、IgG、IgM、CD3^(+)T细胞、CD4^(+)T细胞、CD4^(+)/CD8^(+)降低(P均<0.05)。轻度组、中度组、重度组IgA、IgG、IgM、CD3^(+)T细胞、CD4^(+)T细胞、CD4^(+)/CD8^(+)逐渐降低(P均<0.05)。RE患儿血清1,25-(OH)_(2)D_(3)水平与IgA、IgG、IgM、CD3^(+)T细胞、CD4^(+)T细胞、CD4^(+)/CD8^(+)呈正相关,INF-γ、CD11b水平与IgA、IgG、IgM、CD3^(+)T细胞、CD4^(+)T细胞、CD4^(+)/CD8^(+)呈负相关(P均<0.05)。1,25-(OH)_(2)D_(3)、INF-γ、CD11b诊断小儿RE的曲线下面积分别为0.806(95%CI:0.736~0.864)、0.803(95%CI:0.733~0.862)、0.799(95%CI:0.729~0.858)。结论RE患儿血清1,25-(OH)_(2)D_(3)水平低,INF-γ、CD11b水平高;三者可反映患儿免疫功能及脱水严重程度,并对RE有一定诊断价值。

Objective To investigate the changes in serum 1,25-dihydroxyvitamin D_(3)[1,25-(OH)_(2)D_(3)],gamma interferon(INF-γ)and CD11b levels in children with rotavirus enteritis(RE)and their clinical significance.Methods Totally 108 children with RE were selected(RE group)and were divided into the mild(n=34),moderate(n=50)and severe(n=24)groups according to the severity of dehydration,while 53 healthy children with physical examination were selected as the control group during the same period.Fasting venous blood was collected from the subjects in the early morning and 1,25-(OH)_(2)D_(3) and INF-γwere measured by enzyme-linked immunosorbent assay.Fully automated specific protein analyzer was used to detect the immunoglobulin A(IgA),IgG,IgM,flow cytometry was used to detect CD11b and CD3^(+)T cells,CD4^(+)T cells,and CD8^(+)T cell percentages,and we calculated CD4^(+)/CD8^(+).Pearson correlation was used to analyze the correlation between serum 1,25-(OH)_(2)D_(3),INF-γand CD11b levels and humoral and cellular immune indica‑tors in children with RE,and ROC curves were used to analyze the diagnostic value of each indicator for pediatric RE.Results Serum 1,25-(OH)_(2)D_(3) levels were lower and INF-γand CD11b levels were higher in the RE group than in the control group(all P<0.05).Serum 1,25-(OH)_(2)D_(3) levels gradually decreased and INF-γand CD11b levels gradually increased in the mild,moderate and severe groups(all P<0.05).IgA,IgG,IgM,CD3^(+)T cells,CD4^(+)T cells and CD4^(+)/CD8^(+) were reduced in the RE group as compared with those in the control group(all P<0.05).Serum 1,25-(OH)_(2)D_(3) levels in children with RE were positively correlated with IgA,IgG,IgM,CD3^(+)T cells,CD4^(+)T cells and CD4^(+)/CD8^(+),while INF-γand CD11b levels were negatively correlated with IgA,IgG,IgM,CD3^(+)T cells,CD4^(+)T cells and CD4^(+)/CD8^(+)(all P<0.05).The best cut-off value for 1,25-(OH)_(2)D_(3) for pediatric RE was 25.85 pg/mL,with an area under curve of 0.806(95%CI:0.736-0.864),and the sensitivity,specificity and accuracy were 85.19%,64.15%and 78.26%,respectively;the best cut-off value for INF-γfor pediatric RE was 1.67 pg/mL,with an area under curve of 0.803(95%CI:0.733 to 0.862),the sensitivity of 74.07%,specificity of 81.13%and accuracy of 76.39%,respectively;the best cut-off value for CD11b for pediatric RE was 75.41%,with an area under curve of 0.799(95%CI:0.729 to 0.858),and the sensitivity,specificity and accuracy were 68.52%,81.13%,and 72.67%,respectively.Conclusion Serum 1,25-(OH)_(2)D_(3) levels are low and INF-γand CD11b levels are high in children with RE;these three indicators can reflect the immune function and severity of dehydration in children,and have some diagnostic value for RE.