维生素A治疗对反复呼吸道感染患儿Th1/Th17细胞分化的影响

Influence of vitamin A on Th1/Th17 differentiation in children with repeated respiratory tract infection

目的 探讨维生素A治疗对反复呼吸道感染(RRTI)患儿T辅助(Th)细胞1/Th17细胞分化的影响。方法 选取2017年1月-2019年4月收治于日照市中心医院的300例反复呼吸道感染患儿为研究对象,采用随机数字表法分为研究组和对照组,各150例。对照组采用常规治疗,研究组常规治疗基础上补充维生素A,均治疗3个月。比较两组治疗总有效率,治疗前后外周血Th1和Th17细胞分化比例、血清白细胞介素-17(IL-17)、γ干扰素(IFN-γ)、免疫功能指标及外周血酪氨酸激酶/信号转导及转录激活蛋白(JAK/STAT)信号通路蛋白[pSTAT3/STAT3、pSTAT4/STAT4信号分子、T-box转录因子(T-bet)和维A酸相关孤独受体γt(ROR-γt)]表达水平。结果 治疗后,研究组患儿总有效率和维生素A水平高于对照组(P<0.05),研究组患儿外周血Th1、Th17细胞分化比例和血清IL-17、IFN-γ水平均低于对照组(P<0.05);研究组患儿外周血pSTAT3/STAT3、pSTAT4/STAT4灰度值、T-bet和ROR-γt mRNA表达量均低于对照组(P<0.05);且研究组患儿IgG、IgA、IgM、CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)水平均高于对照组(P<0.05)。结论 补充维生素A辅助治疗RRTI患儿可降低JAK/STAT信号通路相关蛋白表达而减少Th1、Th17细胞异常分化,提升患儿免疫功能,临床疗效明显。

OBJECTIVE To explore the influence of vitamin A on differentiation of T helper(Th)/Th17 cells in children with repeated respiratory tract infection(RRTI). METHODS A total of 300 children with RRTI who were treated in Rizhao Central Hospital from Jan 2017 to Apr 2019 were recruited as the study subjects and randomly divided into the study group and the control group, with 150 cases in each group. The control group was given conventional therapy, while the study group was given additional vitamin A supplement on basis of the conventional therapy, both groups were treated for 3 months. The total effective rate of treatment was compared between the two group, the percentages of Th1 and Th17 cells differentiation in peripheral blood and the expression levels of serum interleukin-17(IL-17), interferon-γ(IFN-γ), immune function indexes, peripheral blood tyrosine kinase/signal transducer and activator of transcription(JAK/STAT),signaling pathway proteins [pSTAT3/STAT3, pSTAT4/STAT4 signaling molecules, T-box transcription factor(T-bet) and retinoic acid-related orphan receptor γt(ROR-γt)] were observed and compared between the two groups before and after the treatment. RESULTS The total effective rate of treatment and vitamin A level were significantly higher in the study group than in the control group after the treatment(P<0.05);the percentages of differentiation of Th1 and Th17 cells in peripheral blood were significantly lower in the study group than in the control group(P<0.05). The gray values of peripheral blood pSTAT3/STAT3 and pSTAT4/STAT4 and expression levels of T-bet and ROR-γt mRNA were significantly lower in the study group than in the control group(P<0.05);the levels of IgG, IgA, IgM, CD_(3)^(+),CD_(4)^(+) and CD_(4)^(+)/CD_(8)^(+) of the study group were significantly higher than those of the control group(P<0.05). CONCLUSION Adjuvant treatment with vitamin A may reduce the expression of JAK/STAT signaling pathway-related proteins so as to reduce the abnormal differentiation of Th1 and Th17 and enhance the immunity of the children with RRTI, with the clinical effect remarkable.