肺炎支原体肺炎患儿血清T辅助细胞亚群水平变化及意义

doi:10.3877/cma.j.issn.1673-5250.2015.04.004

目的

探讨肺炎支原体肺炎(MPP)患儿血清T辅助细胞(Th)水平变化及其在MPP发病机制中的意义。

方法

选择2011年5～12月在青岛大学医学院附属医院及青岛市中心医院儿科住院并确诊的71例肺炎患儿，以及同期于青岛大学医学院附属医院儿童保健门诊体检的15例正常儿童为研究对象。根据肺炎是否由肺炎支原体(MP)导致，将71例肺炎患儿分为MPP组(n＝36)及非MPP(NMPP)组(n＝35)；15例正常儿童则纳入正常对照组。采集肺炎患儿急性期及正常儿童外周静脉血3 mL，采用双抗体夹心酶联免疫吸附测定(DAS-ELISA)法检测受试者血清干扰素(IFN)-γ及白细胞介素(IL)-4水平，并统计学分析血清IFN-γ、IL-4及IFN-γ/IL-4水平在各组的差异。3组受试者年龄及性别构成比比较，差异无统计学意义(P>0.05)。

结果

3组受试者细胞因子水平比较：MPP组血清IFN-γ及IL-4水平显著高于正常对照组[(173.1±29.2) ng/L vs (152.3±28.2) ng/L, (124.8±34.7) ng/L vs (80.0±24.6) ng/L]，而IFN-γ/IL-4则显著低于正常对照组[(1.6±0.7) vs (2.2±1.1)]，且差异均有统计学意义(P<0.05)；MPP组血清IFN-γ及IFN-γ/IL-4水平显著低于NMPP组[(173.1±29.2) ng/L vs (192.2±36.4) ng/L，(1.6±0.7) vs (2.2±1.0)]，而IL-4水平则显著高于NMPP组[(124.8±34.7) ng/L vs (100.4±31.9) ng/L]，且差异均有统计学意义(P<0.05)；NMPP组血清IFN-γ及IL-4水平均显著高于正常对照组[(192.2±36.4) ng/L vs (152.3±28.2) ng/L, (100.4±31.9) ng/L vs (80.0±24.6) ng/L]，且差异有统计学意义(P<0.05)，而两组IFN-γ/IL-4水平比较，差异则无统计学意义(P>0.05)。

结论

MPP患儿急性期Th1/Th2应答失衡，Th2相对呈优势状态；这种免疫失衡在MPP的免疫病理损伤及肺外并发症发生过程中可能具有重要意义。

关键词: 支原体，肺炎, T淋巴细胞，辅助诱导, 儿童

Objective

To study the level changes of serum T helper cells in children with mycoplasmal pneumonia(MPP) and its significance in pathogenesis of MPP.

Methods

A total of 71 children who were hospitalized and made a definite diagnosis as pneumonia in Department of Pediatrics in the Affiliated Hospital of Qingdao University and Qingdao Central Hospital from May to December in 2011, and 15 normal children took physical examination in Department of Child Health in the Affiliated Hospital of Qingdao University at the same time were chosen as study objects.According to pneumonia caused by Mycoplasma pneumonia(MP) or not, 71 pneumonia children were divided into MPP group (n=36) and non MPP (NMPP) group (n=35), and 15 normal children were bringing into normal control group.Collected 3 mL peripheral venous blood of children in three groups.The peripheral blood concentrations of interferon(IFN)-γ and interleukin(IL)-4 of all subjects were detected by double antibody sandwich enzyme-linked immunosorbent assay(DAS-ELISA). The different levels of serum IFN-γ, IL-4 and the ratio of IFN-γ/IL-4 among 3 groups were compared by statistical method.There were no significant differences among 3 groups in age and sex constituent ratio(P>0.05).

Results

Comparison of cytokine levels in 3 groups of subjects: Levels of serum IFN-γ and serum IL-4 in MPP group were higher than those in normal control group[(173.1±29.2) ng/L vs (152.3±28.2) ng/L, (124.8±34.7) ng/L vs (80.0±24.6) ng/L], but the ratio of IFN-γ/IL-4 was lower than that of normal control group[(1.6±0.7) vs (2.2±1.1)], and the differences were statistically significant(P<0.05); Level of serum IFN-γ and the ratio of IFN-γ/ IL-4 in MPP group were lower than those in NMPP group[(173.1±29.2) ng/L vs (192.2±36.4) ng/L, (1.6±0.7) vs (2.2±1.0)], but the level of serum IL-4 was higher than that of NMPP group[(124.8±34.7) ng/L vs (100.4±31.9) ng/L], and the differences were statistically significant(P<0.05); Levels of serum IFN-γ and serum IL-4 in NMPP group were higher than those in normal control group[(192.2±36.4) ng/L vs (152.3±28.2) ng/L, (100.4±31.9) ng/L vs (80.0±24.6) ng/L], and the differences were statistically significant(P<0.05), but there was no significant difference between two groups in ratio of IFN-γ/IL-4(P>0.05).

Conclusions

There was an response imbalance of Th1/Th2 in MPP children in acute phase and Th2 was relative to a dominant status.This immune imbalance may have important significance in immune pathological damage and the pathogenesis of pulmonary complications of MPP.

Key words: Mycoplasma pneumoniae, T-Lymphocytes, helper-inducer, Child

表1 3组受试者细胞因子水平比较(±s)

组别	例数	IFN-γ(ng/L)	IL-4(ng/L)	IFN-γ/IL-4
MPP组	36	173.1±29.2	124.8±34.7	1.6±0.7
NMPP组	35	192.2±36.4	100.4±31.9	2.2±1.0
正常对照组	15	152.3±28.2	80.0±24.6	2.2±1.1
F值		8.58	11.61	5.03
P值		<0.01	<0.01	<0.01

表1 3组受试者细胞因子水平比较(±s)

组别	例数	IFN-γ(ng/L)	IL-4(ng/L)	IFN-γ/IL-4
MPP组	36	173.1±29.2	124.8±34.7	1.6±0.7
NMPP组	35	192.2±36.4	100.4±31.9	2.2±1.0
正常对照组	15	152.3±28.2	80.0±24.6	2.2±1.1
F值		8.58	11.61	5.03
P值		<0.01	<0.01	<0.01

图1 3组受试者血清IFN-γ和IL-4水平比较

图2 3组受试者血清IFN-γ/IL-4比较

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Serum T helper cell subsets level changes in children with mycoplasmal pneumonia and its significance

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Serum T helper cell subsets level changes in children with mycoplasmal pneumonia and its significance