摘要
目的探讨传染性单核细胞增多症(IM)患儿外周血T淋巴细胞亚群CD4^(+)/CD8^(+)比值和血清白细胞介素-6(IL-6)水平的变化及临床意义。方法选取2020年6月至2021年6月汉中市人民医院收治的51例感染EB病毒的IM急性期患儿作为研究组,并选取同期51例正常体检儿童作为对照组。研究组患儿均给予抗病毒、抗炎等对症治疗,于治疗前(急性期)、治疗后(恢复期:病程满1个月)均采取血液样本检测外周血T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、免疫球蛋白(IgA、IgG、IgM)、炎症细胞因子[IL-6、肿瘤坏死细胞-α(TNF-α)、γ干扰素(IFN-γ)]以及EBV DNA载量。对照组患儿仅抽取一次血液标本进行相关指标检测。比较两组受检者的上述各项指标水平的差异,并采用Pearson分析法分析EBV DNA载量与各指标之间的相关性。结果研究组患儿急性期外周血T淋巴细胞CD3^(+)、CD8^(+)水平分别为(81.34±4.97)%、(54.26±9.98)%,明显高于对照组的(66.59±5.14)%、(26.78±5.86)%,差异均有统计学意义(P<0.05);研究组患儿急性期CD4^(+)水平及CD4^(+)/CD8^(+)比值分别为(17.41±5.47)%、0.32±0.12,明显低于对照组的(36.57±5.41)%、1.37±0.57,差异均有统计学意义(P<0.05);研究组患儿恢复期CD3^(+)、CD8^(+)水平分别为(74.12±6.68)%、(41.12±8.49)%,明显低于急性期患儿,CD4^(+)及CD4^(+)/CD8^(+)比值分别为(26.98±6.85)%、0.67±0.24,明显高于急性期患儿,差异均有统计学意义(P<0.05);研究组患儿急性期IgA、IgG、IL-6、TNF-α及IFN-γ水平明显高于对照组,而恢复期患儿的IgA、IgG、IL-6、TNF-α及IFN-γ水平明显低于急性期患儿,差异均有统计学意义(P<0.05);研究组患儿恢复期EBV DNA载量水平为(1.62±0.23)×103 copies/mL,明显低于急性期患儿的(4.23±1.14)×103 copies/mL,差异有统计学意义(P<0.05);经Pearson相关性分析结果显示,EBV DNA载量水平与IL-6、TNF-α、IFN-γ均呈正相关(r=0.613、0.514、0.466,P<0.05),与CD4^(+)/CD8^(+)比值呈负相关性(r=-0.394,P<0.05)。结论IM患儿急性期T淋巴细胞亚群CD4^(+)/CD8^(+)比值降低,血清IL-6等炎症因子水平升高,检测其水平变化可预测其疾病转归。
Objective To explore the changes and clinical significance of peripheral blood CD4^(+)/CD8^(+)ratio and serum interleukin-6(IL-6)in children with infectious mononucleosis(IM).Methods A total of 51 children with Epstein-Barr virus(EBV)infection during acute IM admitted to Hanzhong People's Hospital between June 2020 and June 2021 were enrolled as study group,while 51 normal children undergoing physical examination during the same period were enrolled as control group.The children in the study group were given antiviral,anti-inflammatory and other symptomatic treatments.Before treatment(acute phase)and after treatment(recovery phase:course of disease>1 month),blood samples were collected to detect peripheral blood T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),immunoglobulins(IgA,IgG,IgM),inflammatory cytokines[IL-6,tumor necrosis factor-α(TNF-α),γinterferon(IFN-γ)],and EBV DNA load.In the control group,blood samples were collected only once to detect the related indexes.The levels of the above indexes were compared between the two groups.The correlation between EBV DNA load and different indexes was analyzed by Pearson analysis.Results The levels of peripheral blood T lymphocytes CD3^(+)and CD8^(+)during acute phase in study group were(81.34±4.97)%and(54.26±9.98)%,which were significantly higher than(66.59±5.14)%,(26.78±5.86)%in the control group(P<0.05).CD4^(+)level and CD4^(+)/CD8^(+)ratio during acute phase in study group were(17.41±5.47)%and 0.32±0.12,which were significantly lower than(36.57±5.41)%,1.37±0.57 in control group(P<0.05).In the study group,levels of CD3^(+)and CD8^(+)during recovery phase were(74.12±6.68)%and(41.12±8.49)%,which were significantly lower than those during acute phase,and the CD4^(+)level and CD4^(+)/CD8^(+)ratio were(26.98±6.85)%and 0.67±0.24,significantly higher than those during acute phase(P<0.05).During acute phase,the levels of IgA,IgG,IL-6,TNF-α,and IFN-γin the study group were significantly higher than those in the control group;during recovery phase,the levels of IgA,IgG,IL-6,TNF-α,and IFN-γin the study group were significantly lower than those during acute phase,with statistically significant differences(P<0.05).In the study group,EBV DNA load level during recovery phase was lower than that during acute phase:(1.62±0.23)×103 copies/mL vs(4.23±1.14)×103 copies/mL(P<0.05).Pearson correlation analysis showed that EBV DNA load level was positively correlated with IL-6,TNF-αand IFN-γ(r=0.613,0.514,0.466,P<0.05),while negatively correlated with CD4^(+)/CD8^(+)ratio(r=-0.394,P<0.05).Conclusion CD4^(+)/CD8^(+)ratio of T lymphocyte subsets in children with IM in acute phase decreased,and the levels of serum inflammatory factors such as IL-6 increased.Detecting their changes can help predict disease outcomes.
作者
刘彩霞
赵有丽
高阿宁
LIU Cai-xia;ZHAO You-li;GAO A-ning(Department of Pediatrics,Hanzhong People's Hospital,Hanzhong 723000,Shaanxi,CHINA;Department of Pediatrics,Xianyang Central Hospital,Xianyang 712000,Shaanxi,CHINA)
出处
《海南医学》
CAS
2022年第22期2917-2920,共4页
Hainan Medical Journal
基金
陕西省咸阳市2020年重点研发计划项目(编号:2020K02-98)。
