反复呼吸道感染儿童细胞免疫与体液免疫研究

Study on cellular immunity and humoral immunity in children with recurrent respiratory tract infection

目的探讨细胞免疫状态和体液免疫状况与儿童反复呼吸道感染(recurrent respiratory infection,RRTI)的关系。方法选取2012年7月至2016年7月,南京医科大学附属江宁医院确诊为RRTI的患者90例(RRTI组),并以同期90例社区获得性肺炎患儿(肺炎组)和90例健康体检儿童(正常组)作为对照,采用流式细胞仪检测所有患儿T细胞亚群,采用酶联免疫吸附法检测血清中免疫球蛋白,采用logistics回归探讨患儿反复呼吸道感染发生的风险因素。结果 RRTI组、肺炎组和正常组患儿CD3^+、CD4^+、CD4^+/CD8^+水平间差异均有统计学意义(F=4.21、3.92、4.08,P<0.05)。三组患儿IgA、IgG、IgM水平间的差异均有统计学意义(F=4.76、5.14、5.53,P<0.05)。多因素logistic分析显示,低水平IgA(OR=1.78, 95%CI:1.06～2.23)和CD4^+/CD8^+(OR=1.65,95%CI:1.52～2.32)是RRTI的独立危险因素。结论血清中IgA和CD4^+/CD8^+水平低是患者发生RRTI的独立危险因素。

Objective To understand the relationship between cellular immunity, humoral immunity in children and recurrent respiratory tract infection(RRTI). Methods From July 2012 to July 2016, 90 cases with confirmed RRTT in Jiangning Hospital Affiliated to Nanjing Medical University were enrolled in the study. Meanwhile, 90 cases with community-acquired pneumonia and 90 healthy children were also included as controls. Blood samples were collected and T cell subsets were determined using flow cytometry. Serum immunoglobulin was detected by using ELISA. Logistic regression method was used to analyze the risk factors of RRTI in children. Results The percentages of CD3^+, CD4^+ and CD4^+/CD8^+ ratio were significant different among children in three groups(F=4.21, 3.92, 4.08, P<0.05). The differences of serum levels of IgA, IgG and IgM were also statistically significant(F=4.76,5.14,5.53,P<0.05). Logistic regression analysis showed that the OR of low level IgA was 1.78( 95%CI:1.06-2.23), and the OR of low level CD4^+/CD8^+ ratio was 1.65(95%CI:1.52-2.32). Conclusions Low serum level of IgA and low CD4^+/CD8^+ ratio are independent risk factors for RRTI in children.