不同分期川崎病患儿外周血体液和细胞免疫指标变化的研究

Changes of humoral and cellular immune indexes in peripheral blood of children with Kawasaki disease at different stages

目的探讨川崎病(KD)患儿在急性期、亚急性期和恢复期外周血干扰素γ(IFN-γ)、白细胞介素(IL)-4水平及辅助性T细胞(Th)1/Th2平衡的变化。方法选取2017年5月至2020年1月在电子科技大学医学院附属妇女儿童医院/成都市妇女儿童中心医院接受诊治的KD患儿41例作为观察组,另选择同期健康体检儿童41例作为对照组。观察组KD患儿于急性期和恢复期均行结核菌素纯蛋白衍生物(PPD)试验;采用酶联免疫吸附法(ELISA)检测观察组患儿急性期、亚急性期、恢复期和对照组儿童的血清免疫球蛋白IgG、IgA、IgM、IgE水平和血清IFN-γ和IL-4水平。结果观察组恢复期患儿PPD皮试阳性率高于急性期患儿[65.85%(27/41)比17.07%(7/41)],差异有统计学意义(χ^(2)=20.10,P<0.05)。观察组急性期、亚急性期、恢复期血清IgG、IgA、IgM和IgE水平逐渐降低(P<0.05);观察组恢复期血清IgG、IgA、IgM和IgE水平与对照组比较差异无统计学意义(P>0.05)。观察组急性期、亚急性期、恢复期血清IFN-γ、IFN-γ/IL-4水平均逐渐升高,血清IL-4水平逐渐降低,差异有统计学意义(P<0.05)。观察组恢复期血清IFN-γ、IL-4和IFN-γ/IL-4水平与对照组比较差异无统计学意义(P>0.05)。结论KD患儿急性期血清IFN-γ水平降低,IL-4水平升高,Th1/Th2平衡向Th2漂移。随着病情稳定,血清IFN-γ、IL-4水平逐渐恢复,Th1/Th2平衡呈恢复趋势,进入恢复期后基本恢复正常。

Objective To investigate the dynamic change characteristics of peripheral blood interferon-γ(INF-γ),interleukin(IL)-4 levels and T helper cell(Th)1/Th2 balance in acute,subacute and restoration stages of children with Kawasaki disease(KD).Methods Forty-one children with KD received treatment in Women′s and Children′s Hospital Affiliated of School of Medicine University of Electronic Science and Technology of China,Chengdu Women′s and Children′s Central Hospital from May 2017 to January 2020 were enrolled as the observation group,and 41 healthy children examinee from the same period were enrolled as the control group.Children with KD of the observation group were performed with tuberculin pure protein derivative(PPD)test when acute and restoration stage of KD respectively.Peripheral venous blood were drawn from KD children of the observation group in acute,subacute and restoration stage and the control group respectively,serum immune globulin IgG,IgA,IgM and IgE,serum IFN-γand IL-4 levels were detected by enzyme linked immunosorbent assay(ELISA).Results Positive rates of PPD test in the restoration stage was higher than that in the acute stage:65.85%(27/41)vs.17.07%(7/41),there was statistical difference(χ^(2)=20.10,P<0.05).The levels of serum IgG,IgA,IgM and IgE in the acute stage,subacute stage and restoration stagewere gradually decreased(P<0.05).The levels of serum IgG,IgA,IgM and IgE in the restoration stage and the control group had no significant differences(P>0.05).The levels of serum IFN-γand IFN-γ/IL-4 in the acute stage,subacute stage and restoration stage were gradually increased(P<0.05),the level of IL-4 was gradually decreased(P<0.05),but the levels of serum IFN-γ,IL-4 and IFN-γ/IL-4 in the restoration stage and the control group had no significant differences(P>0.05).Conclusions Among the children with KD in acute stage,serum level of IFN-γis decreased while serum IL-4 level is increased,and Th1/Th2 balance shifts to Th2.Along with the stabilization of disease,the levels of serum IFN-γand IL-4 are normalized,and Th1/Th2 balance presents a recovering trend and they almost recover to normal after entering the restoration stage.