摘要
目的 探讨中重型颅脑创伤患儿血浆急性时相反应蛋白变化对其细胞免疫功能的影响。方法 于创伤后第1、3、7和14d抽取外周静脉血,测定26例中重型颅脑创伤患儿血浆C-反应蛋白、铜蓝蛋白、α_1-酸性糖蛋白、α_1-抗胰蛋白酶、补体C_3、C_4、转铁蛋白、纤维连接蛋白以及前白蛋白等项指标;同时应用链霉亲和素-碱性磷酸酶(streptavidin-alkaline phosphatase,SAP)法检测T-淋巴细胞亚群功能。结果 颅脑创伤后,患儿体内T-淋巴细胞(CD_3)总数、T-辅助细胞(CD_4)和 CD_4/CD_8比值下降,T-抑制细胞(CD_8)增高(均P<0.01);而血浆C-应蛋白、铜蓝蛋白、α_1-酸性糖蛋白和α_1-抗胰蛋白酶水平增高,补体C_3、C_4及转铁蛋白、纤维连接蛋白与前白蛋白水平下降(均P<0.01)。直线相关分析显示,CD_4/CD_8比值与血浆C-反应蛋白、铜蓝蛋白、α_1-酸性糖蛋白和α_1-抗胰蛋白酶水平呈负相关(P<0.01);与补体C_3、C_4及转铁蛋白、纤维连接蛋白与前白蛋白水平呈正相关(P<O.01)。结论 中重型颅脑创伤后,患儿细胞免疫功能的下降可能与急性时相反应蛋白各项指标的改变有关,其中血浆C-反应蛋白、铜蓝蛋白、α_1-酸性糖蛋白和α_1-抗胰蛋白酶具有抑制细胞免疫作用;而补体C_3、C_4、转铁蛋白、纤维连接蛋白与前白蛋白则可能具有协同作用。
Objective To study the influence on immune function of T-lymphocytes with the changes of acute phase plasma proteins in children with acute moderate and severe brain injury. Methods The acute phase reaction proteins (APRPs) including C-reaction protein (CRP), ceruloplasmin (CP), ctj-acidic glycopro-tein(tti-AG), arantitrypsin (oti-AT), fibronectin (FN), prealbumin (PA), transferrin (TF), C3, C4 were determined in 26 children patients in 1, 3, 7 and 14 d after moderate or severe cerebral injury. Meanwhile the function of T-lymphoe,yte subsets was determined by streptavidin-alkaline phosphatase (SAP). A total of 20 healthy children with the matched age selected randomly were enrolled in control group. Results The results of linear correlation analysis showed that CRP, CP, arAT, arAG and CD8 were significantly elevated (P<0.01) after injury, but FN, PA, TF, C3, C4, CD3, CD4, CD4 /CD8 ratio were lowered than those in the control group (P< 0.01). A negative correlation between CD4/CD8 ratio and CRP, CP, α1-AT, α1-AG was found in the injury group, while there was a positive correlation between CDyCDg ratio and C3, C4, FN, PA, TF. Conclusions Lower cellular immune function occurred in children with acute moderate or severe cerebral injury, which may be correlated with the changes of APRPs. In these proteins CRP, CP, α1-AT, α1-AG play a role in suppressing cell-mediated immunity, while FN, PA, TF, C3 and C4 may have the synergistic action.
