儿童急性呼吸窘迫综合征外周血淋巴细胞亚群和IL-6、IL-10动态变化研究

Dynamic changes of peripheral blood lymphocyte subsets and IL-6 and IL-10 in pediatric acute respiratory distress syndrome

目的通过动态观察不同分度的儿童急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者外周血淋巴细胞亚群及细胞因子白细胞介素(interleukin,IL)-6、IL-10的变化,研究其在病情评估中的作用。方法收集2018年6月至2021年5月入住福建省妇幼保健院儿科重症监护病房(pediatric intensive care unit,PICU)治疗的儿童ARDS患者52例作为病例组,根据入院时氧合指数(PaO_(2)/FiO_(2),P/F),分为轻度、中度、重度三组;同时随机选取本院儿童保健科体检健康的20例儿童作为对照组。流式细胞术检测外周血淋巴细胞亚群,酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测血清IL-6、IL-10浓度,分析淋巴细胞亚群及细胞因子在不同严重组别儿童ARDS患者中的变化规律。结果对照组与ARDS患儿各组间的性别、年龄、体重比较差异无统计学意义(P>0.05);与轻、中度组ARDS患儿相比,重度组ARDS患儿入院P/F比值明显降低、PICU住院时间、住院总时间明显延长,差异有统计学意义(F=166.00、12.42、10.24,P值均<0.001)。ARDS患儿组与对照组淋巴细胞亚群比较结果显示,入院第1天,与正常对照组相比,轻、中、重三组ARDS患儿淋巴细胞亚群CD3^(+)T、CD4^(+)T、CD8^(+)T、CD19^(+)B、CD56NK均显著降低,差异有统计学意义(F=365.00、415.47、500.56、281.53、50.18,P值均<0.001);入院第8天时,轻度组各淋巴细胞亚群与对照组比较差异无统计学意义(P>0.05),中度组仍明显低于对照组,重度组仍明显低于对照组和轻、中度组,差异均有统计学意义(P<0.001)。ARDS患儿组与对照组IL-6和IL-10比较结果显示,入院第1天,与正常对照组相比,轻、中、重三组ARDS患儿IL-6、IL-10均明显升高,差异有统计学意义(F=1162.99、1018.15,P值均<0.001);入院第3天时,轻度组IL-6、IL-10与对照组比较差异无统计学意义(P>0.05);入院第8天时,中度组IL-6、IL-10与对照组比较差异无统计学意义(P>0.05),重度组仍明显高于对照组和轻、中度组,差异均有统计学意义(F=462.36、672.16,P值均<0.001)。结论儿童ARDS患者急性期存在外周血淋巴细胞亚群下降和IL-6、IL-10升高,其变化程度和恢复速度均与病情密切相关,二者动态监测可作儿童ARDS病情评估的辅助指标。

Objective To explore the role in disease assessment by dynamically observing the changes of peripheral blood lymphocyte subsets and cytokine interleukin(IL)-6 and IL-10 in children with pediatric acute respiratory distress syndrome(ARDS)of different severity.Methods Total of 52 children with ARDS admitted to the pediatric intensive care unit(PICU)in Fujian Maternity and Child Health Hospital from June 2018 to May 2021 were collected and divided into three groups:mild,moderate and severe groups according to the oxygenation index(PaO_(2)/FiO_(2),P/F)at admission.At the same time,20 healthy children who underwent physical examination in Child Health Care Department in our hospital were randomly selected as the normal control group.Flow cytometry was used to detect peripheral blood lymphocyte subsets,and enzyme-linked immunosorbent assay(ELISA)was used to detect serum IL-6 and IL-10 concentrations.The changes of lymphocyte subsets and cytokines were analyzed in different severity groups of children with ARDS.Result There was no statistically significant difference in the comparison of gender,age,and weight among the control group and the groups of children with ARDS(P>0.05).Compared with the mild to moderate group,the admission P/F ratio of severe group was significantly reduced,and the PICU hospitalization time and total hospitalization time were significantly prolonged(F=166.00,12.42,10.24,all P values<0.001).The comparison results of lymphocyte subsets between the ARDS patient group and the control group showed that on the 1st day of admission,compared with the control group,the lymphocyte subsets CD3^(+)T,CD4^(+)T,CD8^(+)T,CD19^(+)B and CD56NK were significantly decreased in the mild,moderate and severe groups(F=365.00,415.47,500.56,281.53,50.18,all P values<0.001).On the 8th day of admission,there was no statistically significant difference in lymphocyte subsets between the mild group and the control group(P>0.05).The lymphocyte subsets in the moderate group was still significantly lower than the control group,and the severe group was still significantly lower than the control group and the mild and moderate groups(P<0.001).The comparison results of IL-6 and IL-10 between the ARDS patient group and the control group showed that on the 1st day of admission,compared with the normal control group,the levels of IL-6 and IL-10 were significantly increased in the mild,moderate and severe groups(F=1162.99,1018.15,both P value<0.001).On the 3rd day of admission,there was no statistically significant difference between IL-6 and IL-10 in the mild group and the control group(P>0.05).On the 8th day of admission,there was no statistically significant difference in IL-6 and IL-10 between the moderate group and the control group(P>0.05),while the severe group was still significantly higher than the control group and mild and moderate groups(F=462.36、672.16,all P values<0.001).Conclusion The decrease of peripheral blood lymphocyte subsets and the increase of IL-6 and IL-10 in children's ARDS in the acute stage are closely related to the disease condition,which can be used as auxiliary indicators for the assessment of the children's ARDS disease condition.