免疫治疗对儿童抗NMDAR脑炎免疫功能的影响

Effect of immunotherapy on immune function in children with anti-NMDAR encephalitis

目的探讨免疫治疗对儿童抗N-甲基-D-天门冬氨酸受体(NMDAR)脑炎免疫功能的影响机制。方法应用流式细胞术检测抗NMDAR脑炎患儿免疫治疗(治疗组)治疗前后及健康对照组儿童外周血淋巴细胞亚群水平(包括CD16^(+)56、CD4^(+)、CD8^(+)、CD19^(+)淋巴细胞和CD4^(+)/CD8^(+)等);应用化学发光法检测治疗组患儿治疗前后及健康对照组儿童外周血炎性细胞因子水平[包括白细胞介素(IL)-6、IL-10和肿瘤坏死因子-α(TNF-α)等]。结果治疗组患儿治疗前CD16^(+)56、CD8^(+)、CD4^(+)/CD8^(+)水平与健康对照组比较,差异均无统计学意义(P>0.05);治疗后CD16^(+)56、CD4^(+)/CD8^(+)水平均显著低于治疗前和同期健康对照组,CD4^(+)/CD8^(+)水平均显著高于治疗前健康对照组,差异均有统计学意义(P<0.05);两组研究对象CD4^(+)水平比较,差异无统计学意义(P>0.05);治疗组患儿治疗前后CD19^(+)水平均显著高于健康对照组,治疗后CD19^(+)水平显著降低,但仍显著高于健康对照组,差异均有统计学意义(P<0.05);治疗组患儿治疗前IL-6、IL-10、TNF-α水平均显著高于治疗后和健康对照组,差异均有统计学意义(P<0.05);治疗后IL-6、IL-10、TNF-α水平与健康对照组,差异均无统计学意义(P>0.05)。结论免疫治疗主要影响体液免疫反应而发挥其作用。

Objective To investigate the effect mechanism of immunotherapy on the immune function of children with anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.Methods The peripheral blood lymphocyte subsets were detected by the flow cytometry before and after immunotherapy in children patients with anti-NMDAR encephalitis and healthy control group(including CD16^(+)56,CD4^(+),CD8^(+),CD19^(+)lymphocytes and CD4^(+)/CD8^(+)ratio);the values of cytokines were detected by chemiluminescence method in peripheral blood before and after treatment in children patients with anti-NMDAR encephalitis and healthy control group(including IL-6,IL-10 and TNF-α).Results The levels of CD16^(+)56,CD8^(+)lymphocytes and CD4^(+)/CD8^(+)before treatmentin had no statistical differences between the treatment group and healthy control group;the levels of CD16^(+)56,CD4^(+)/CD8^(+)after treatment in the treatment group were significantly lower than those before treatment and the healthy control group,CD4^(+)/CD8^(+)level was significantly higher than that before treatment in the healthy control group,and the difference was statistically significant(P<0.05).The CD4^(+)level had no statistical difference between thw two groups(P>0.05);the CD19^(+)level before and after treatment group in the treatment group was significantly higher than that in the healthy control group,the CD19^(+)level after treatment was significantly decreased,but was still higher than that in the healthy control group,and the differences were statistically significant(P<0.05);the IL 6,IL 10 and TNFαlevels before treatment in the treatment group were signifcantly higher than those after treatment and in the healthy control group,and the difference was statistically significant(P<0.05);the levels of IL-6,IL-10 and TNF-αafter treatment in the treatment group had no statistically significant difference compared with the healthy control group.Conclusion Immunotherapy mainly affects the humoral immunity reaction to play the effect.