母B族链球菌定植致新生儿巨噬细胞相关细胞因子及免疫功能改变的研究

Study on changes of macrophage-related cytokines and cellular immune function in newborns induced by colonization of mother group B streptococcus

目的:探讨母B族链球菌(GBS)定植致新生儿巨噬细胞相关细胞因子及免疫功能改变的研究。方法:前瞻性选取2020年3月至2022年1月广州医科大学附属第二医院收治确诊为母GBS定植的新生儿43例(研究组)及同期健康新生儿40例(对照组)。对比两组巨噬细胞相关细胞因子及T淋巴细胞亚群水平、NK细胞水平。分析母GBS定植后新生儿的临床表现。结果:研究组CD3^(+)T、CD19+T、CD3^(+)CD8^(+)T、CD4^(+)/CD8^(+)T、NK细胞水平均高于对照组,CD3^(+)CD4^(+)T低于对照组(P<0.05)。研究组患儿IFN-γ、IL-13、IL-4、IL-10水平均高于对照组(P<0.05)。研究组患儿血清巨噬细胞移动抑制因子(MIF)、CXCL9、CXCL10、CCL3水平均高于对照组(P<0.05)。Person相关性分析显示,血清CD3^(+)T、CD19^(+)T、CD3^(+)CD8^(+)T、CD4^(+)/CD8^(+)T、NK细胞水平、IFN-γ、IL-13、IL-4、IL-10、MIF、CXCL9、CXCL10、CCL3与新生儿GBS感染呈正相关,CD3^(+)CD4^(+)T水平与新生儿GBS感染呈负相关(P<0.05)。研究组新生儿出现呼吸窘迫4例,休克1例,败血症2例,脑膜炎1例,胃液培养阳性2例。预后与转归结果为研究组均治愈出院。结论:巨噬细胞相关细胞因子及T淋巴细胞亚群水平参与了新生儿GBS感染的免疫应答过程,巨噬细胞相关细胞因子及免疫功能的改变与新生儿GBS感染相关。孕晚期母GBS PCR筛查有利于识别早发型GBS感染。

Objective:To explore the study of mother group B streptococcus(GBS)colonization causing macrophage cytokine and cellular immune function alterations in newborns.Methods:Forty-three neonates with confirmed maternal GBS colonization admitted to the Second Affiliated Hospital of Guangzhou Medical University from March 2020 to January 2022 were prospectively selected and set as the study group,while forty normal newborns at the same time period were control group.The levels of macrophage-related cytokines and T lymphocyte subsets,and NK cell levels were compared between two groups.The clinical manifestations that appeared in neonates after GBS colonization were analyzed.Results:The levels of CD3^(+)T,CD19^(+)T,CD3^(+)CD8^(+)T,CD4^(+)/CD8^(+)T,and NK cells were higher in study group than control group,and CD3^(+)CD4^(+)was lower than control group(P<0.05).The levels of IFN-γ,IL-13,IL-4,IL-10 were higher in the children of study group than control group(P<0.05).The levels of serum macrophage migration inhibitory factor(MIF),CXCL9,CXCL10 and CCL3 were higher in study group than control group(P<0.05).Levels of CD4^(+)/CD8^(+)T cells,NK cells,IFN-γ,IL-13,IL-4,IL-10,MIF,CXCL9,CXCL10 and CCL3 were proved to be positively correlated with neonatal GBS infection,and levels of CD3^(+)CD4^(+)T cells were negatively correlated with neonatal GBS infection(P<0.05).There were 4 cases of respiratory distress,1 case of shock,2 cases of sepsis,1 case of meningitis and 2 cases of positive gastric fluid culture in study group of neonates.Prognosis and regression:all study groups were discharged cured.Conclusion:Macrophage-associated cytokines and T lymphocyte subpopulation levels are involved in the immune response process of neonatal GBS infection,and macrophage-associated cytokines and altered cellular immune function are associated with neonatal GBS infection.Maternal GBS PCR screening in late pregnancy is beneficial in identifying early-onset GBS infection.