喘息急性发作期儿童肠道微生态学改变及其与血浆Th1/Th2的相关性

The changes of intestinal microecology in children during the acute episode of wheezing and its correlation with plasma Th1/Th2

目的探讨喘息急性发作期儿童肠道微生态学改变及其与血浆Th1细胞/Th2细胞(Th1/Th2)的相关性。方法选取2019年6月~2020年10月于绍兴市柯桥区妇幼保健院儿科就诊的下呼吸道感染患儿85例为研究对象,根据患儿的临床症状分为喘息组(45例)和非喘息组(40例),并选择同期在绍兴市柯桥区妇幼保健院体检后的35名健康儿童作为对照组。比较各组儿童的双歧杆菌、大肠杆菌数量、肺功能指标[第1秒最大呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)%、最大呼气流量(PEF)]、血浆干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)的表达情况,计算双歧杆菌/大肠杆菌(B/E)、IFN-γ/IL-4,并采用Pearson相关性分析法分析B/E比值与IFN-γ、IL-4、IFN-γ/IL-4的相关性。结果三组患儿的大肠杆菌数量差异无统计学意义(均P>0.05),喘息组患儿的双歧杆菌数量、B/E水平为(5.05±0.83)copies/g、(0.64±0.12),均明显低于非喘息组的[(6.17±0.90)copies/g、(0.80±0.17)]和对照组的[(8.82±1.14)copies/g、(1.21±0.22)],且非喘息组明显低于对照组(P<0.05);喘息组患儿的FEV1、FEV1/FVC、PEF水平分别为(73.50±7.41)L、(71.49±4.83)%、(74.57±6.29)L/min,均明显低于非喘息组的[(90.25±5.23)L、(82.90±5.31)%、(92.64±5.50)L/min]和对照组的[(96.41±4.86)L、(88.35±4.95)%、(106.90±5.44)L/min],且非喘息组明显低于对照组(均P<0.05);喘息组患儿的血清IFN-γ、IL-4水平分别为(981.65±124.74)ng/L、(683.52±94.00)ng/L,均明显高于非喘息组的[(606.70±83.05)ng/L、(300.95±46.45)ng/L]和对照组的[(520.30±56.61)ng/L、(205.90±33.37)ng/L],且非喘息组明显高于对照组,IFN-γ/IL-4明显低于非喘息组和对照组,非喘息组明显低于对照组(均P<0.05);经Pearson相关分析结果显示,B/E比值与IFN-γ、IL-4均呈负相关,与IFN-γ/IL-4呈正相关(均P<0.05)。结论喘息急性发作期儿童肠道菌群紊乱可导致B/E值降低,血浆Th1/Th2免疫状态失衡,有助于评估患儿病情的严重程度。

Objective To explore the changes of intestinal microecology in children during the acute episode of wheezing and their correlation with plasma Th1 cells/Th2 cells(Th1/Th2).Methods A total of 85 children with lower respiratory tract infection admitted to Shaoxing Keqiao District Maternal and Child Health Care Hospital from June 2019 to October 2020 were selected for study,and divide into wheezing group 45 cases and non-wheezing group 40 cases according to the children′s clinical symptoms,and select the same period 35 healthy children after physical examination in Maternity and Child Health Hospital of Keqiao District of Shaoxing City served as the control group.The number of bifidobacteria,Escherichia coli,lung function indicators[forced expiratory volume in one second(FEV1),ratio of FEV1 to forced vital capacity(FEV1/FVC)%,peak expiratory flow(PEF)],plasma the expression of interferon-γ(IFN-γ)and interleukin-4(IL-4),bifidobacteria/escherichia coli(B/E)ratio and IFN-γ/IL-4 ratio were compared,and Pearson correlation analysis was used to analyze the correlation between B/E ratio and IFN-γ,IL-4 and IFN-γ/IL-4.Results There was no significant difference in the number of Escherichia coli among the three groups(P>0.05),the number of bifidobacteria and B/E level in the asthmatic group were(5.05±0.83)copies/g and(0.64±0.12)copies/g,which were significantly lower than those in the non asthmatic group[(6.17±0.90)copies/g and(0.80±0.17)]and the control group[(8.82±1.14)copies/g and(1.21±0.22)],and those in the non asthmatic group were significantly lower than those in the control group(all P<0.05);the levels of FEV1,FEV1/FVC and PEF in the asthmatic group were(73.50±7.41)L,(71.49±4.83)%and(74.57±6.29)L/min,which were significantly lower than those in the non asthmatic group[(90.25±5.23)L,(82.90±5.31)%and(92.64±5.50)L/min]and the control group[(96.41±4.86)L,(88.35±4.95)%and(106.90±5.44)L/min],and those in the non asthmatic group were significantly lower than those in the control group(all P<0.05);the levels of serum IFN-γ,IL-4 in asthmatic group were(981.65±124.74)ng/L and(683.52±94.00)ng/L,which were significantly higher than those in the non asthmatic group[(606.70±83.05)ng/L,(300.95±46.45)ng/L]and the control group[(520.30±56.61)ng/L and(205.90±33.37)ng/L],and the IFN-γ/IL-4 in the non asthmatic group was significantly higher than that in the control group was significantly lower than that in non asthmatic group and control group,and that in non asthmatic group was significantly lower than that in control group(all P<0.05);Pearson correlation analysis showed that B/E ratio and IFN-γ,IL-4 was negatively correlated with IFN-γ/IL-4 was positively correlated(all P<0.05).Conclusion In children with acute onset of wheezing,intestinal microflora disorder may lead to decreased B/E value,and imbalance of plasma Th1/Th2 immune status,may help to assess the severity of the child's condition.